One in five young ED patients in crisis with conditions like attempted suicide, self-harm, and depression are boarded.

Mental health issues are becoming more common and resources are harder to find, leading to too-long waits.

Parents in the United States are facing a shortage of community mental health resources for their children, according to the American Academy of Child and Adolescent Psychiatry. The group reports that the shortage of psychiatric providers — including school counselors, therapists, and child psychologists — has reached a critical level. In fact, there are only about 7,400 psychiatrists for a child and adolescent population of more than 74 million.

Primary care clinicians estimate that 20% of pediatric patients will need psychiatric treatment at some point. Furthermore, providers are distributed unequally, with the worst shortages in rural and impoverished areas.

Boarding in EDs

Because of the lack of behavioral health care options, more children in a state of crisis are being seen in emergency departments. While long ED waits are often par for the course, behavioral health patients face longer stays, often in a boarding situation lasting more than 24 hours.

According to a report by the American College of Emergency Physicians, one in five young ED patients with conditions like attempted suicide, self-harm, and depression are boarded. Patients wait to be evaluated by mental health specialists, then social workers and case managers spend hours attempting to locate additional care for transfer.

A high rate of boarding in the ED is often linked to poorer patient outcomes and readmissions. Other ripple effects include caregiver frustration, fewer beds and longer wait times for everyone, and a loss of hospital revenue.

Tackling the ED Boarding Dilemma

How can EDs take on the challenge of providing more timely care for this vulnerable patient population? A 2022 report from the Mayo Clinic found that of 2,300 U.S. hospitals surveyed, only 54% reported having a psychiatrist on staff or on call for ED consultation. In spite of provider shortages, there are options.


By accessing providers virtually through a telemedicine service, EDs can provide timely assessment of patients, which can hasten the process of finding treatment. This care delivery model serves to resolve the supply-demand provider imbalance as well as distribution issues in rural and underserved areas.

Flow and Capacity Issues

Each health care organization, ED, and community has its own constraints when it comes to caring for patients. A study published in the American Journal of Emergency Medicine looked at boarding data, noting trends and the effect of boarding count on other specific metrics. The study concluded that “by using advanced analytics in daily ED operations, time series analysis provided multiple useful insights into boarding and its impact on performance metrics.”

Some of these insights included:

  • ED boarding should be analyzed in the context of throughput and ED crowding across the organization.
  • Specific patient populations, including behavioral health patients, tend to have some seasonality in flow.
  • Boarding has a quantifiable impact on LWBS, overall LOS, waiting room LOS, and patient satisfaction surveys.
  • Other mitigating interventions — including having a provider in triage, adding telemedicine, and expanding other services — have a quantifiable impact on ED metrics.

Improvement Through Data Analysis

Access and throughput problems that result in the boarding of pediatric mental health patients can be improved.  Poor patient flow and boarding is a hospital-wide problem. By analyzing facility data, specifically around boarded patients, organizations can enable the conversation necessary to target action plans that make a real difference.

Is your facility experiencing a surge in ED boarding? Contact d2i to find out how advanced analytics can pinpoint the solutions that make the largest impact for your patients and providers. Request a demo and get started!