Emergency Department Length of Stay for Children with Mental Health Conditions Spikes

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By Christopher Cheney

For pediatric patients with mental health conditions, prolonged lengths of stay in emergency departments increased significantly during the coronavirus pandemic, according to a new research article.

The pandemic has had a negative impact on the mental health of children due to factors such as caregiving disruptions and social isolation. Last month, the American College of Emergency Physicians and 34 other healthcare organizations raised alarm over the boarding of patients in emergency departments for days or weeks, including pediatric patients with mental health conditions.

The new study, which was published by the Journal of the American College of Emergency Physicians Open, is based on data collected from January 2020 to December 2021 at 107 emergency departments in 29 states. The study features several key data points:

  • At emergency departments, pediatric mental health visits with a length of stay greater than 12 hours accounted for 20.9% of all pediatric mental health visits
  • At emergency departments, pediatric mental health visits with a length of stay greater than 24 hours accounted for 7.3% of all pediatric mental health visits
  • At emergency departments, pediatric non-mental health visits with a length of stay greater than 12 hours accounted for 1.8% of all pediatric visits
  • At emergency departments, pediatric non-mental health visits with a length of stay greater than 24 hours accounted for 0.2% of all pediatric visits
  • The monthly counts of pediatric emergency department visits for mental health conditions peaked at 2,455 in September 2021
  • The monthly counts of pediatric mental health visits with a length of stay greater than 6 hours peaked at 975 in November 2021
  • At emergency departments, the most common diagnoses for pediatric mental health visits with a length of stay greater than 24 hours were suicide, self-injury, and depressive disorders

The data show aspects of the pandemic’s negative impact on healthcare, the study’s co-authors wrote. “In this sample of 107 EDs in 29 states, visit counts with prolonged LOS >24 hours more than doubled in some months since the arrival of COVID-19. These findings are indicative of an increasingly strained emergency and mental health system.”

In a prepared statement, the lead author of the study said the data reflect a lack of access to mental health care in many communities.

“A cycle of compounding system failures is hindering care for many of our most vulnerable patients. Insufficient access to mental health care stands out among the factors that contribute to prolonged stays in the nation’s emergency departments—there are too few options outside of emergency care for patients in many communities,” said Alexander Janke, MD, MHS, national clinical scholar at the VA Ann Arbor Healthcare System and University of Michigan Institute for Healthcare Policy and Innovation.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.