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

Jennifer A Hoffmann*, Anne M. Stack, Mihail Samnaliev, Michael C. Monuteaux, Lois K. Lee

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

54 Scopus citations

Abstract

Objective: Analyze trends in visit numbers, length of stay (LOS), and costs of pediatric mental health emergency department (ED) visits over time. Methods: We conducted a cross-sectional, time-series analysis from 2010 to 2016 of mental health visits, identified by billing diagnosis codes, among children 5 to 18years 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 ≥ 24hours. We used time-series analysis to trend median costs per visit. Results: From 2010 to 2016, there were 197,982 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 ≥ 24hours 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 ≥ 24hours, and visit costs are increasing over time. Additional hospital and community resources are needed to address rising ED utilization for mental illness in children.

Original languageEnglish (US)
Pages (from-to)386-393
Number of pages8
JournalAcademic Pediatrics
Volume19
Issue number4
DOIs
StatePublished - May 1 2019

Funding

Financial Disclosure: This study was supported by the Michael Shannon Grant from the Division of Emergency Medicine at Boston Children's Hospital and the House Officer Development Award from the Medical Staff Organization of Boston Children's Hospital. The funding sources did not have any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Keywords

  • emergency care
  • mental health
  • pediatrics
  • resource utilization

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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