62 - The Operational Impact of the Pediatric Mental Health Crisis on the Emergency Department During the COVID-19 Pandemic

Emergency departments (EDs) have long served as a social safety net for children seeking acute mental health resources. The COVID-19 pandemic introduced new psychological stressors, likely worsening the existing pediatric mental health crisis. There is limited data analyzing the long-term operational impact of the COVID-19 pandemic on ED utilization by children with mental health concerns.

Objective:

1) Compare the number of ED visits and length of stay (LOS) prior to and throughout the COVID-19 pandemic and 2) Compare the 30-day-return rate for pediatric patients with mental health concerns.

Design/Methods:

We conducted a retrospective cohort study at a large tertiary care pediatric ED. The study population included patients aged 5-18 years old presenting to the ED for mental or behavioral health concerns before the COVID-19 pandemic (March 11, 2019 through March 10, 2020) and during the first two years of the pandemic (March 11, 2020 through March 11, 2022). Outcome variables included LOS, number of visits, and return rates. We used Fisher's exact test of proportions and Mann-Whitney Test statistical analyses methods.

Results:

There were 3,002 ED visits for patients with mental health-related chief complaints in the year prior to COVID-19 and 6,120 visits during the first two years of the pandemic, with a median age of 15 years. The proportion of total ED visits for mental health evaluations increased from 8% to 11% (p< 0.001). The median LOS for these patients increased by 30%, from 6.5 hours to 8.5 hours (p< 0.001). In comparison, the median LOS for patients with non-mental health-related chief complaints increased by 7%, from 2.9 to 3.1 hours (p< 0.001). The rate of return to the ED within 30 days for patients with mental health complaints also increased from 9% to 12% (p=0.002). Throughout the study period, 23% of all pediatric patients who presented with mental health concerns (1,451 patients) had two or more visits, cumulatively accounting for 47% of total ED visits for mental health evaluations (4,278 visits).

Conclusion(s):

An increase in LOS in the ED for children with mental health-related chief complaints during the pandemic suggests insufficient inpatient and outpatient resources to adequately meet the growing needs of this population. Despite longer lengths of stay, return rates continue to increase. Future directions should focus on expanding acute community and hospital-based psychiatric resources for children and providing prompt follow-up care to reduce ED utilization.