目的:在等待精神科入院的同时,在急诊科和住院医疗楼层内“寄宿”儿科患者的做法显着增加。这项研究旨在为该人群的临床护理提供共识指南。
方法:55名初始参与者中的23名小组参与者(回应率41.8%)承诺使用Delphi共识收集方法完成4轮连续提问。大多数(70%)是儿童精神科医生,代表17个卫生系统。
结果:13名参与者(56%)建议在ED中维持寄宿患者,而78%的人表示在急诊室的登机时间限制应促使转移到住院儿科。在这个群体中,65%的人建议24小时阈值。大多数参与者(87%)建议不要在与成年人相同的空间中照顾儿科患者。一致同意急诊医学或住院医生保持对患者护理的主要所有权,而91%的人同意儿童精神病学应该保持咨询作用。获得社会工作被认为对人员配备最重要,其次是行为健康护理,精神病医生,孩子的生活,康复服务,最后是学习专家。一致认为每日评估是必要的,79%的人表示生命体征应每12小时获得一次。所有人都同意,如果现场没有儿童精神病提供者,虚拟咨询足以提供心理健康评估。
结论:这项研究强调了第一个全国共识小组关于在医院环境中照顾青年寄宿的发现,并为规范临床实践提供了有希望的开端,同时为未来的研究工作提供了信息。
In 2021, several professional organizations declared a national state of emergency in child and adolescent mental health. Rising volume and acuity of pediatric mental health emergencies, coupled with reduced access to inpatient psychiatric care, has caused tremendous downstream pressures on EDs resulting in long lengths of stay, or \"boarding\", for youth awaiting psychiatric admission. Nationally, boarding times are highly heterogeneous, with medical / surgical patients experiencing much shorter boarding times compared to patients with primary mental health needs. There is little guidance on best practices in the care of the pediatric patient with significant mental health need \"boarding\" in the hospital setting.
There is a significant increase in the practice of \"boarding\" pediatric patients within emergency departments and inpatient medical floors while awaiting psychiatric admission. This study aims to provide
consensus guidelines for the clinical care of this population.
Twenty-three panel participants of fifty-five initial participants (response rate 41.8%) committed to completing four successive rounds of questioning using Delphi
consensus gathering methodology. Most (70%) were child psychiatrists and represented 17 health systems.
Thirteen participants (56%) recommended maintaining boarded patients in the emergency department, while 78% indicated a temporal limit on boarding in the emergency department should prompt transfer to an inpatient pediatric floor. Of this group, 65% recommended a 24-hour threshold. Most participants (87%) recommended not caring for pediatric patients in the same space as adults. There was unanimous agreement that emergency medicine or hospitalists maintain primary ownership of patient care, while 91% agreed that child psychiatry should maintain a consultative role. Access to social work was deemed most important for staffing, followed by behavioral health nursing, psychiatrists, child life, rehabilitative services, and lastly, learning specialists. There was unanimous
consensus that daily evaluation is necessary with 79% indicating vitals should be obtained every 12 hours. All agreed that if a child psychiatric provider is not available on-site, a virtual consultation is sufficient to provide mental health assessment.
This study highlights findings of the first national
consensus panel regarding the care of youth boarding in hospital-based settings and provides promising beginnings to standardizing clinical practice while informing future research efforts.