An initiative to reduce psychiatric boarding in a Cape Town emergency department

Clint A Hendrikse; Peter Hodkinson; Daniël J van Hoving

doi:10.4102/sajpsychiatry.v29i0.2075

An initiative to reduce psychiatric boarding in a Cape Town emergency department

S Afr J Psychiatr. 2023 Nov 14:29:2075. doi: 10.4102/sajpsychiatry.v29i0.2075. eCollection 2023.

Authors

Clint A Hendrikse^{1

2}, Peter Hodkinson¹, Daniël J van Hoving³

Affiliations

¹ Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
² Emergency Department, Mitchells Plain Hospital, Cape Town, South Africa.
³ Division of Emergency Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.

Abstract

Background: Psychiatric boarding in Emergency Departments (ED) is a global challenge which results in long ED length of stays (LOS) with significant consequences on patient care and staff safety.

Aim: This study investigated the impact of an initiative to reduce psychiatric boarding on LOS and readmission rate, as well as explored the relationship between boarding times and LOS.

Setting: This study was conducted at Mitchells Plain Hospital, a large district-level hospital in Cape Town.

Methods: This cross-sectional study collected data for 24 months, which included a 9-month period prior to the initiative and 16 months thereafter. Data were collected retrospectively from official electronic patient registries. The initiative comprised of inpatient hallway boarding as a full-capacity protocol with the accompanying capacitation of psychiatric wards to accommodate the additional burden.

Results: The initiative was associated with a decrease of 95% (p < 0.001) in boarding time, 13% (p < 0.001) in ward LOS and 25% (p < 0.001) in hospital LOS. Ward LOS were found to be independent of ED boarding times. The readmission rate increased from 12% to 18% post intervention.

Conclusion: The initiative resulted in a sustainable improvement in boarding times and LOSs. The observational nature of this study precludes concrete conclusions and further investigations into psychiatric inpatient hallway boarding are recommended.

Contribution: Inpatient hallway boarding could be a feasible option to reduce the risk. Psychiatric boarding times in the ED are independent of ward LOS, rendering it devoid from any value from a lean and economic perspective.

Keywords: access block; crowding; emergency medicine; psychiatric boarding; readmission rate.