TABLE 2.

Summary of Best Practice Recommendations for the Care of Youth Boarding in Emergency Department and Hospital Settings

Definition

Boarding is a status when a disposition decision has been made to admit a pediatric patient to an inpatient psychiatric unit, but an inpatient psychiatric bed is not available within a four-hour window, regardless of where the patient is temporarily located.

Treatment environment A specific amount of time should be used as a determining factor in requesting an inpatient pediatric bed for longer term boarding and moving patients out of emergency departments. Boarding youth should be cared for in a pediatric specific setting. Boarding youth should not be cared for in a locked care space used for concurrent adult care. Boarding youth should have access to observed bathroom privileges (safety). Boarding youth should have access to a private interview space.

Staffing Pediatrics or emergency medicine should maintain ownership of the care of boarding youth. Psychiatry (child psychiatry) should maintain a consulting role. Psychiatry (child psychiatry) staffing models may vary, but handoffs between team members are the most important factor in ensuring care coordination and continuity of care. Multidisciplinary teams caring for boarded youth should include social work and behavioral health nursing. Child life, occupational therapy and other milieu therapies would benefit boarding youth if available as a part of standard of care regardless of patient location. A nontreating team member should be assigned the task of locating an inpatient psychiatric bed.

Service delivery Boarding youth should be evaluated by psychiatry team daily. Safety planning, psychoeducation, re-evaluation, medication management (including starting new medications), individual and family therapy interventions should be part of treatment provided by psychiatry team. Physical exam should be completed, and vital signs should be checked every 12 hours. Telephonic coverage should be backed up by daily face-to-face assessments (in person or via telepsychiatry) Telepsychiatry coverage is sufficient but not equivalent to in person care. Patients with delirium, catatonia and psychosis will benefit from in person evaluations.