Abstract
Background: The deinstitutionalization of mental health facilities occurred after the Community Mental Health Act, which aimed to transition mental health care from institutions to community centers to deliver psychiatric crisis intervention (Hung et al., 2020). Due to a lack of funding, the Acts' goals were unmet, causing patients to seek care in emergency settings and creating the revolving door phenomenon (Stien et al., 2022). Emergency departments had an increase in patients with mental health conditions of 6.6% to 10.9% over ten years (Kim et al., 2022). Boarding is defined as patients in the emergency department requiring transfer to an outside facility, but no bed is available (Nordstrom et al., 2019).
Purpose: This literature review aims to evaluate the impact of Psychiatric Observation Units (POUs) on boarding times for patients with mental health conditions.
Methods: This literature review utilized PubMed and ProQuest databases to retrieve retrospective, before-and-after analyses, quantitative and qualitative studies published within the last five years. Keywords were related to boarding patients with mental health conditions in emergency departments.
Results: The average boarding time of patients with mental health conditions is 60 hours. Patients boarding in the emergency department do not receive psychiatric treatment due to knowledge deficits related to mental health, extending boarding times up to 35 hours (Nordstrom et al., 2019). Patients with psychotic, neurodevelopmental, and neurocognitive disorders are more likely to board the emergency department (Kraft et al., 2021). Stabilizing patients and initiating treatment of underlying mental health conditions results in discharge from the emergency department and reduced boarding times from 212 to 152 hours (Stamy et al., 2021).
Conclusions: Implementing POUs improves clinical outcomes, reducing recovery and boarding times. Patients with mental health conditions seek treatment in emergency departments due to limited options, limited upstream solutions, and fragmented healthcare. Mental health episodes can lead to emergencies, but leading someone experiencing a mental health episode to the emergency department decreases support and increases risks. Implementing POUs is a downstream solution; however, it gives access to upstream solutions that promote mental wellness and equity. Mental health is a state of mental well-being, not just the absence of a mental diagnosis.
Notes
References:
Hung, P., Busch, S. H., Shih, Y.-W., McGregor, A. J., & Wang, S. (2020). Changes in community mental health services availability and suicide mortality in the US: a retrospective study. BMC Psychiatry, 20(1), 188–188. https://doi.org/10.1186/s12888-020-02607-y
Kim, A. K., Vakkalanka, J. P., Van Heukelom, P., Tate, J., & Lee, S. (2022). Emergency psychiatric assessment, treatment, and healing (EmPATH) unit decreases hospital admission for patients presenting with suicidal ideation in rural America. Academic Emergency Medicine, 29(2), 142–149. https://doi.org/10.1111/acem.14374
Kraft, C. M., Morea, P., Teresi, B., Platts-Mills, T. F., Blazer, N. L., Brice, J. H., & Strain, A. K. (2021). Characteristics, clinical care, and disposition barriers for mental health patients boarding in the emergency department. The American Journal of Emergency Medicine, 46, 550–555. https://doi.org/10.1016/j.ajem.2020.11.021
Nordstrom, K., Berlin, J. S., Nash, S. S., Shah, S. B., Schmelzer, N. A., & Worley, L. M. (2019). Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. Western Journal of Emergency Medicine, 20(5), 690-695. https://doi.org/10.5811/westjem.2019.6.42422Links to an external site
Stamy, C., Shane, D. M., Kannedy, L., Van Heukelom, P., Mohr, N. M., Tate, J., Montross, K., & Lee, S. (2021). Economic Evaluation of the Emergency Department After Implementation of an Emergency Psychiatric Assessment, Treatment, and Healing Unit. Academic Emergency Medicine, 28(1), 82-. https://doi.org/10.1111/acem.14118
Stein, D. J., Shoptaw, S. J., Vigo, D. V., Lund, C., Cuijpers, P., Bantjes, J., Sartorius, N., & Maj, M. (2022). Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration. World psychiatry : official journal of the World Psychiatric Association (WPA), 21(3), 393–414. https://doi.org/10.1002/wps.20998
Sigma Membership
Phi Pi
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Literature Review
Research Approach
N/A
Keywords:
Health Equity or Social Determinants of Health, Transition to Practice or Onboarding, Public and Community Health, Mental Health, Emergency Departments, Psychiatric Observation Units, POUs
Recommended Citation
Baugh, Brandi, "Psychiatric Observation Unit, Patient Outcomes, and Boarding" (2025). International Nursing Research Congress (INRC). 126.
https://www.sigmarepository.org/inrc/2025/presentations_2025/126
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Psychiatric Observation Unit, Patient Outcomes, and Boarding
Seattle, Washington, USA
Background: The deinstitutionalization of mental health facilities occurred after the Community Mental Health Act, which aimed to transition mental health care from institutions to community centers to deliver psychiatric crisis intervention (Hung et al., 2020). Due to a lack of funding, the Acts' goals were unmet, causing patients to seek care in emergency settings and creating the revolving door phenomenon (Stien et al., 2022). Emergency departments had an increase in patients with mental health conditions of 6.6% to 10.9% over ten years (Kim et al., 2022). Boarding is defined as patients in the emergency department requiring transfer to an outside facility, but no bed is available (Nordstrom et al., 2019).
Purpose: This literature review aims to evaluate the impact of Psychiatric Observation Units (POUs) on boarding times for patients with mental health conditions.
Methods: This literature review utilized PubMed and ProQuest databases to retrieve retrospective, before-and-after analyses, quantitative and qualitative studies published within the last five years. Keywords were related to boarding patients with mental health conditions in emergency departments.
Results: The average boarding time of patients with mental health conditions is 60 hours. Patients boarding in the emergency department do not receive psychiatric treatment due to knowledge deficits related to mental health, extending boarding times up to 35 hours (Nordstrom et al., 2019). Patients with psychotic, neurodevelopmental, and neurocognitive disorders are more likely to board the emergency department (Kraft et al., 2021). Stabilizing patients and initiating treatment of underlying mental health conditions results in discharge from the emergency department and reduced boarding times from 212 to 152 hours (Stamy et al., 2021).
Conclusions: Implementing POUs improves clinical outcomes, reducing recovery and boarding times. Patients with mental health conditions seek treatment in emergency departments due to limited options, limited upstream solutions, and fragmented healthcare. Mental health episodes can lead to emergencies, but leading someone experiencing a mental health episode to the emergency department decreases support and increases risks. Implementing POUs is a downstream solution; however, it gives access to upstream solutions that promote mental wellness and equity. Mental health is a state of mental well-being, not just the absence of a mental diagnosis.
Description
Patients with mental health conditions seek solutions for crisis intervention and stabilization in emergency departments. Treatment for patients with mental health conditions in the emergency setting includes physical and chemical restraints, resulting in prolonged boarding times and symptom exacerbation. Implementation of POUs with PMHNPs improves the treatment of mental health conditions and reduces boarding times.