613 - Reducing Boarding Time for Pediatric Patients Presenting with Behavioral Health Concerns at a Community Hospital Emergency Department: A Quality Improvement Project

Publication Number: 1590.613

Aanal Patel, The Brooklyn Hospital Center, Brooklynn, NY, United States; Mohammed Alsabri, St. Christopher's Hospital for Children, Brooklyn, NY, United States

Background: Prolonged behavioral health boarding is a growing challenge in community hospital pediatric emergency departments (ED). At a community hospital, pediatric patients presenting with behavioral health concerns often remain in the ED for 10-12 hours while awaiting transfer or telepsychiatry evaluation. Extended boarding times impact patient safety and contribute to crowding, or family distress.

Objective: To implement and evaluate low-resource interventions to reduce behavioral health boarding time in a community hospital pediatric ED.

Design/Methods: Between September 2025 and February 2026, the QI team implemented four Plan–Do–Study–Act (PDSA) cycles using the Institute for Healthcare Improvement model. Interventions included:
(1) Implemented a behavioral health triage alert to ensure early identification of eligible patients.
(2) Developed a standardized transfer checklist to promote timely and complete documentation.
(3) Introduced early inpatient notifications to alert the pediatric floor team and expedite telepsychiatry preparation.
(4) Established a behavioral health nursing protocol to standardize patient monitoring and enhance safety during transfers.
The primary outcome measure was the median boarding time, defined as the interval from triage to either transfer or telepsychiatry activation. Process and balancing measures included rates of documentation completion and nursing staff feedback on workflow efficiency.

This project is a Quality Improvement initiative. A QI application is pending administrative review. No identifiable patient data were included.

Results: Implementation of triage alert and transfer checklists resulted in a 25% reduction in median boarding time (from 12 hours to 9 hours) and a 20% increase in timely documentation completion compared to baseline data. Nursing staff reported clearer role expectations, improved communication with the inpatient team and reduced workflow delay. Data collection is ongoing, and a complete analysis will be shared at PAS 2026.

Conclusion(s): This project reduced behavioral health boarding times and improved coordination for pediatric patients presenting to a community hospital ED. Through early triage identification, standardized transfer checklists, and structured nursing protocols, the initiative improved communication and expedited care. This practical, staff-driven model can be replicated across other resource-limited community hospitals to enhance patient flow and safety.