391 - Disposition and Outcomes of Mental Health Hospitalizations at a Children’s Hospital

US children’s hospitals have experienced an increase in admissions to their medical units for mental health conditions (i.e., “psychiatric boarding”); however, the clinical outcomes of these hospitalizations have not been well described.


Objective:

To describe the patient characteristics and clinical outcomes of mental health hospitalizations at a children’s hospital and evaluate associations between patient characteristics and disposition destination.


Design/Methods:

We conducted a retrospective cohort study of medically cleared patients hospitalized on a medical unit for a mental health condition at a 600-bed freestanding children’s hospital with no inpatient psychiatric unit. We included patients discharged between October 1, 2020, and September 30, 2022, and excluded patients undergoing treatment for an eating disorder. We examined their demographic characteristics and clinical outcomes. We ascertained primary diagnoses through a validated scheme using ICD-10 codes. We used bivariate statistics and regression modeling to investigate associations between patient characteristics and disposition to an inpatient psychiatric unit versus to the community.


Results:

Our sample included 1,978 hospitalizations for 1,619 unique patients. Patients were 65% female, 42% Black, 41% White, 9% Hispanic and 56% publicly insured. Primary diagnoses were 59% depression, 23% aggression, 6% psychosis, and 12% other mental health conditions. Median age was 14 years (interquartile range: 12-16).

Disposition destination was 53% to an inpatient psychiatric unit and 47% to the community (22% partial hospitalization and 25% outpatient care). Patients discharged to the community had a longer median length of stay at the children’s hospital (5.3 days) compared to those discharged to an inpatient psychiatric unit (3.9 days) (p< 0.001). Physical restraints were used during 12% of encounters. 4% had a 30-day readmission and 13% had a 120-day readmission.

Patients with a primary diagnosis of depression had higher adjusted odds of disposition to an inpatient psychiatric unit (adjusted odds ratio [aOR] 1.84, 95% CI: 1.25-2.70), as did those older than 12 (aOR 1.75, 95% CI: 1.42-2.16). Public insurance was not associated with inpatient disposition (aOR 1.03, 95% CI: 0.84-1.27).


Conclusion(s):

Nearly half of the children admitted to a medical unit for a mental health condition were discharged to the community without inpatient psychiatric treatment. Younger children and children with diagnoses of aggression and psychosis are a priority population for targeted disposition planning early in their hospitalization.