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Acad Pediatr. 2019 Feb 21. pii: S1876-2859(19)30051-8. doi: 10.1016/j.acap.2019.02.006. [Epub ahead of print]

Trends in Visits and Costs for Mental Health Emergencies in a Pediatric Emergency Department, 2010-2016.

Author information

1
Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA. Electronic address: Jennifer.Hoffmann@childrens.harvard.edu.
2
Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA. Electronic address: Anne.Stack@childrens.harvard.edu.
3
Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA. Electronic address: Mihail.Samnaliev@childrens.harvard.edu.
4
Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA. Electronic address: Michael.Monuteaux@childrens.harvard.edu.
5
Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA. Electronic address: Lois.Lee@childrens.harvard.edu.

Abstract

OBJECTIVE:

To analyze trends in visit numbers, length of stay (LOS), and costs of pediatric mental health emergency department (ED) visits over time.

METHODS:

Cross-sectional, time-series analysis from 2010-2016 of mental health visits, identified by billing diagnosis codes, among children 5-18 years old in a tertiary pediatric ED. We used Poisson regression to analyze trends in rates of mental health visits, patient-hours, and visits with LOS ≥ 24 hours. We used time series analysis to trend median costs per visit.

RESULTS:

From 2010-2016, there were 197,982 total ED visits and 13,367 (6.7%) mental health visits. Mental health visits increased by 45%, from 1462 to 2119, compared to a 13% increase in non-mental health visits. The rate of mental health visits increased from 5.6 to 7.1 per 100 ED visits, and increased 5.5% annually, compared to -0.4% annually for non-mental health visits (incidence rate ratio [IRR] 1.06, 95% confidence interval [CI] 1.05, 1.07). Mental health patient-hours increased 186%, compared to an 18% increase in non-mental health patient-hours. The rate of mental health visits with LOS ≥ 24 hours increased from 4.3 to 18.8 per 100 mental health visits, and increased 22% annually (IRR 1.22, 95% CI 1.19, 1.26). Median costs per visit increased by $38 per quarter (95% CI $28, $48).

CONCLUSIONS:

Rates of mental health visits, patient-hours, visits with LOS ≥ 24 hours, and visit costs are increasing over time. Additional hospital and community resources are needed to address rising ED utilization for mental illness in children.

KEYWORDS:

Emergency care; Mental health; Resource utilization

PMID:
30797896
DOI:
10.1016/j.acap.2019.02.006

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