WASHINGTON, D.C.— According to new research in the Journal of the American College of Emergency Physicians (JACEP) Open, the rate of children with mental health emergencies staying in the emergency department for prolonged periods of time is growing.

Between January 2020 and December 2021, one in five children (20.9%) who visited the emergency department with a mental health condition stayed longer than 12 hours, according to data from 107 emergency departments in 29 states analyzed through the American College of Emergency Physicians (ACEP) Clinical Emergency Data Registry (CEDR). The rate of visits where a child stayed longer than 24 hours more than doubled in some months since the beginning of the pandemic, underscoring the strain on mental health care and emergency care.

“A cycle of compounding system failures is hindering care for many of our most vulnerable patients,” said Alexander T. Janke, MD, MHS, National Clinical Scholar at the VA Ann Arbor Healthcare System and University of Michigan Institute for Healthcare Policy and Innovation, and lead study author. “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.”

Children who stayed in the emergency department for 24 hours or longer made up 7.3% of pediatric mental health visits overall, according to CEDR data cited in the study. Some of the most common emergencies among these young patients included suicide attempts, self-harm, and depression.

Patients’ length of stay contributes significantly to “boarding,” when admitted patients are held in the emergency department as they wait for additional care or transfer.

ACEP is sounding the alarm about the dangers arising from boarding in emergency departments. Current ACEP efforts to address the boarding crisis include a letter to the White House requesting a stakeholder summit, ongoing discussions with bipartisan members of Congress and regulators, and the collection of more than 100 heart-wrenching stories straight from the physicians on the frontlines.

Better tracking of metrics that include length of stay can help emergency departments and hospitals address factors that contribute to systemic challenges such as boarding, the authors add.

“Emergency department length of stay should be a standardized measure of care access and quality,” said Dr. Janke. “Along with patient presentations and admissions, these criteria can be quantified to monitor and enhance emergency department-based treatment, while assessing the functioning of the acute care system and informing mental health care integration across settings of care.”