The boarding crisis: Why some kids are waiting days in the ER for psychiatric ward beds

Pediatric ER boarding times have increased in major cities in the pandemic, fueled by stressors inflicted by the coronavirus crisis and limited psychiatric beds.

When Carly Birmingham, a 7th grader from Massachusetts who identifies as nonbinary, was depressed and experiencing suicidal thoughts last fall, their mother drove to a local hospital emergency department at 2 a.m. hoping for immediate help. But Carly says they ended up spending 14 days waiting for a psychiatric inpatient bed (seven in the emergency department (ED) and seven in a patient room) at Boston Children's Hospital in what doctors and other experts describe as a troublesome and increasing practice that leads in many cases to substandard care for vulnerable patients -- boarding. "After a few days, I almost regretted [going to the hospital]. We were there, we were getting no sleep, and I wasn't even getting any help. I was just sitting there waiting for a bed. And we didn't know how long it was gonna take," Carly, of Arlington, Massachusetts, told ABC News. Boston Children's declined comment about Birmingham's care citing privacy laws. While there is no standard definition for boarding, the American College of Emergency Physicians describes it as the practice of holding patients in the ED after they have been evaluated because no inpatient beds are available or are awaiting transfer to another facility, which can result in lengthy wait times, possibly increased suffering among patients and strains overburdened EDs.