A Multidisciplinary Initiative Improves Care for Psychiatric Patients Boarding in the Emergency Department

Emergency departments (EDs) in the United States face increasing challenges caring for psychiatric patients, resulting in prolonged boarding and delayed treatment. This single-institution quality improvement initiative used a multidisciplinary approach focused on improving efficiency and use of resources to improve care for psychiatric patients in the ED. Following implementation, time to triage decreased 23% (30-23 minutes), and patients leaving without treatment dropped from 6.5% to 4.2%. The authors showed a 24.9% reduction in time to medication for agitation (from 3.0 to 2.2 hours). ED boarding time for admitted patients decreased 10.9% (981-874 minutes), while ED length of stay for discharged patients increased 9.9% (403-443 minutes). Physical restraint use in the ED dropped 7.1% (112-104 events), with total restraint time decreasing 27.7% (4.7-3.4 hours). Results remain variably sustained at 2 years. This initiative demonstrated that structured, team-based interventions can significantly improve psychiatric emergency care.