(PS13-C52) Characteristics of Pediatric Inpatient Psychiatric Unit Admissions Prior to and Following the COVID-19 Pandemic

The increasing prevalence of youth mental health concerns has been a longstanding concern, with approximately one in five youth living with a mental health disorder (Perou et al., 2013). Since the onset of the COVID-19 pandemic, rates of mental health concerns and youth presenting to the emergency department in psychiatric crisis has doubled (Racine et al., 2021). This has resulted in a marked influx of patients being admitted to inpatient psychiatric units (IPUs) for evaluation, stabilization, and transition to outside care. While there is some emerging literature showing promise for evidence-based practices (EBPs) on IPUs (Thompson, Leffler et al., 2022), it remains quite limited. To assist with the ongoing development of EBPs on IPUs, we must have an improved understanding of the relationship between patient demographics, average length of stay, and rates of IPU readmissions in different regions of the United States. Furthermore, we need to examine if these relationships have changed due to the COVID-19 pandemic.

This retrospective study used electronic health records to examine demographic information, length of stay, and rates of readmission for patients (N=1,348) admitted to a Mountain West children’s hospital IPU prior to (March 17, 2019-March 16, 2020) and following (March 17, 2020-March 16, 2021) the onset of the COVID-pandemic. These dates were selected to align with when the state from which this data came declared a statewide shutdown.

A total of 733 patients were admitted (55.8% female sex, 65.6% White, 93.3% English speaking) to the IPU between March 2019 and March 2020. Of these patients, 69 patients were re-admitted at least twice, with 1 being admitted 4 times that year. Patients stayed from 1 to 286 days, with the average length of stay being 8.07 (SD = 15.54) days. Patients’ ages ranged from 6 to 17, with the mean being 13.44 (SD = 2.48) years old. Most patients (65.9%) had a primary mood disorder diagnosis, followed by 14.2% having a trauma-related primary diagnosis. From March 2020 to March 2021, a total of 615 patients were admitted (67.8% female sex, 75.92% White, 93.8% English speaking). Of these patients, 99 patients were re-admitted at least twice, with 2 of these patients being admitted 5 times that year. Patients stayed from 1 to 197 days, with the average length of stay being 10.19 (SD = 15.48) days. Patients’ ages ranged from 5 to 17, with the mean being 13.50 (SD = 2.56) years old. Most patients (60.3%) had a primary mood disorder diagnosis, followed by 14.5% having a trauma-related primary diagnosis. T-tests were conducted to assess between-group differences with regards to length of stay and age at admission. Results showed patients admitted before the pandemic (M = 8.07, SD = 15.54) stayed significantly less days than patients admitted following the pandemic (M = 10.19, SD = 15.48), t(1325) = -2.50, p< .01. No significant differences were found with regards to age at admission.

This study found that the average length of IPU admission was significantly longer for youth admitted following the onset of the pandemic. While the cause of this longer admission is likely multi-faceted (e.g., higher acuity, limited disposition options), it highlights the importance of ensuring clinical care models are adjusted to reflect this change.