Presentations

Abstract

Introduction: The American Academy of Pediatrics (AAP) Pediatric Acute & Critical Care (PACC) Quality Network, is implementing, with over 80 Children's Hospitals participating, interventions to improve the care of patients presenting to emergency care with acute mental health complaints including but not limited to: reduction in physical restraint usage, reduction in the use of routine labs for medical clearance/stabilization, increase in lethal means restriction counseling, and increase in daily suicide risk re-assessment in patients awaiting transfer to inpatient psychiatric treatment facilities. CHKD is actively enrolled in this 18 month project beginning Winter '24 to conclude in Summer '25. The scope of this poster is to establish baseline characteristics of children receiving universal suicidal screening who present to the ED with primary psychiatric complaints, within the broader parameters of this PACC coordinated project.

Methods: A retrospective chart review of pediatric CHKD ED patients, aged 12 to 18 years, with a primary psychiatric complaint from 4/1/2023 to 3/31/2024 Were eligible for inclusion; random number generation was used to select twelve per month for Inclusion and analysis. Analysis included ED length of stay (LOS), disposition, Suicide Screening Questionnaire (SSQ) completion, SSQ results, physical restraint rates, and rate of intramuscular medications for agitation (IMA).

Results: Of the 144 patients, the ED LOS was 13.5 hours (SD 19.7). Dispositions included a 46.5% discharge rate, 53.5% admission rate (34%CHKD and 19.5% to other inpatient facilities). Of the 142 (98.6%) patients with an SSQ completed, the average score was a 4 (SD 3.2). Two (1.3%) of these SSQ-screened patients had a repeat SSQ completed prior to discharge. Three (2.1%) were physically restrained and nine (6.3%) had IMA administered.

Conclusion: In this sample of adolescent ED patients, almost all were screened for suicidality and the majority of patients were admitted to an inpatient service. Physical restraint and IMA rates were comparable to similarly published reports. Future interventions are in process to improve care for this vulnerable clinical population.