After COVID-19 exacerbated instances of patient boarding in Minnesota emergency departments — that some say reached "unprecedented levels" — the Minnesota Medical Association and the state chapter of the American College of Emergency Physicians have outlined a direction for change related to psychiatric patients.
Boarding happens when a hospital lacks bed availability and patients are instead held in the emergency department while they wait for a bed to become available, something that can quickly become an issue for overwhelmed staff in a fast-moving, critical area of the hospital.
In Minnesota specifically, instances of this have repeatedly happened with pediatric patients. In some cases, children needing mental health services were held in the emergency department for hours or even days, waiting.
In the report from the two medical groups, physicians listed multiple recommendations for inflow factors, stalling, outflow factors and more.
Ten of the recommendations from the report are:
- Support the creation of a Minnesota ED Boarding database.
- Develop a strategy to improve the size, distribution, and diversity of the state's mental healthcare workforce.
- Expand telehealth use for mental health services.
- Financially support 988 call centers throughout Minnesota.
- Explore the option of transport diversion to hospital emergency departments that have appropriate inpatient mental health beds.
- Develop and evaluate other options for emergency facilities for patients who have a psychiatric diagnosis and are waiting on disposition.
- Boost the number of designated mental healthcare workers in emergency departments.
- Increase the number of inpatient mental health hospital beds statewide.
- Reduce corporate foster care's use of emergency department boarding.
- Increase the number of residential treatment beds in Minnesota.
Ultimately, the crisis of ED boarding is one that "is complex and requires a multitude of interventions from various stakeholders," the report states.
According to The Joint Commission psychiatric patient boarding is a safety risk that should not last longer than four hours. It also notes that at the root of the nationwide problem is "lack of funding for community mental health clinics, intensive outpatient programs, community crisis stabilization units, respite services, and inpatient psychiatric units/ beds," according to a 2021 blog post.