Background From 2019 to 2023 there were 478 adolescent patients put on legal 5150 holds for danger to self and taken to one of the three emergency departments of Alameda Health System of Alameda County California, which encompasses Oakland. Many of these adolescent patients had extended stays at the emergency department waiting for disposition to an inpatient bed. Some of the stays lasted up to three weeks. The average was 5 to 7 days which essentially was the duration of the hold, which meant that the inpatient treatment was done in the emergency department.
Method Meetings were held by the departments of emergency medicine, psychiatry and social services to understand this serious problem and develop a solution. Community leaders of adolescent crisis stabilization facilities, inpatient hospitals and county crisis management were included as well. Out of these meetings, interventions were developed to address the problem. Rates of adolescent boarding were tracked over a 16-month period of time to assess the success of the interventions.
Results A significant improvement was found following a concerted effort to understand and resolve the serious problem of adolescent boarding at the health system emergency departments. Through a collaboration of multiple health departments and county crisis and inpatient facilities, adolescent boarding was significantly reduced.
Conclusion By identifying the precipitating factors related to the problem of adolescent boarding in Alameda County and improving communication and collaboration between emergency, crisis and inpatient facilities, a significant reduction in adolescent boarding Alameda Health System emergency departments was achieved.
Learning Objectives:
Understand the problem of adolescent boarding at Alameda Health System in the context of a national problem of adolescent boarding at emergency departments.
Understand the process of developing successful interventions to mitigate the problem of adolescent boarding.
Understand how the efforts to reduce adolescent boarding were achieved.
