Emergency department pediatric psychiatric services: Measurement of variation and identification of best practice

The annual volume of pediatric psychiatric visits to hospital emergency departments (EDs) continues to increase significantly, but little is known about the mental health services that are provided to children and adolescents in this setting. Anecdotal sources portray substantial interorganizational variation in service arrangements; but a more systematic collection of this information is warranted. A comparative examination of ED pediatric psychiatric services' structures and outcomes serves to identify disparities and to facilitate the development of strategies for service improvement. The purpose of the reported research was to evaluate the feasibility of a proposed data measurement and collection procedure for identifying ED pediatric psychiatric service characteristics. To determine the instrument's suitability for use with a national sample, a 26-item survey was pilot tested with ED administrators of nonfederal acute-care facilities from the Commonwealth of Virginia. Analyses of survey data assess the reliability of the instrument, the extent to which the variables of interest are measured appropriately, and compare various survey formats (online, phone interview and paper) for variance in completeness and administration time. This research represents one of the first efforts to capture the variation in ED pediatric emergency services and compare outcomes on a multiorganizational scale. Implications of the findings for replication of the research design using a national sample will be discussed. Such information will inform legislators, hospitals, and other personnel involved in ED pediatric psychiatric service development and evaluation.