Boarding of Psychiatric Patients in Critical Access Hospital Emergency Departments

ABSTRACT Purpose: The purpose of this article is to review the impact of boarding psychiatric patients in Critical Access Hospital (CAH) Emergency Departments (ED) why psychiatric patients are being boarded in the ED, how limited to no formal psychiatric care is provided for the patient’s mental health conditions, how it impacts the flow in the ED, how care of other medical patients in the ED is affected and how this impacts the staff in the ED. Method: A PubMed literature search was conducted with search terms, psychiatric boarding, boarding in the Emergency Department, Critical Access Hospitals, and Health Care Violence. Forty-three pertinent articles were retrieved and referenced in this article. Conclusion: Boarding of psychiatric patients in ED’s significantly impacts not only the care of the psychiatric patient, due to lack of psychiatric care, but also the flow of patients in the ED and affects the care of more acute patients in the ED. This is even more evident when boarding psychiatric patients in a rural CAH ED, which has extremely limited bed capacity, no in-house psychiatric care, and is often already boarding acute medical patients awaiting admission to the hospital. The Alameda model, which provides a dedicated psychiatric hospital, has been shown to significantly reduce ED boarding by 80 percent. An additional result of boarding psychiatric patients in the ED is increased violence. As many as 78 percent of ED staff have been assaulted, making the ED second only to law enforcement for workplace violence. Being assaulted in the ED must no longer be tolerated as “part of the job”