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Objectives <p>To provide mental health follow-up appointments within 96&#xa0;h of emergency department (ED) discharge to 100% of eligible pediatric patients within one year of implementation and describe demand patterns for ED mental health presentations.</p> Methods <p>Two Canadian pediatric EDs implemented an urgent mental health follow-up appointment process for discharged children who lacked existing access to a mental health provider. Six additional sites contributed data to evaluate visit volume patterns. The arrival date for mental health presentations at all 8 sites was collected, as were date and time of discharge and follow-up appointment for sites A and B. The primary outcome, proportion of appointments meeting the 96-h aim, was calculated for every ten consecutive patients and displayed as a p-chart. Association between aim achievement and day of week was assessed using a chi-square test of independence. For all sites, proportion of ED visits by day of week and month were compared using a chi-square goodness of fit test.</p> Results <p>Four hundred and thirty-one children were given a follow-up appointment. 75% of appointments at site A and 62% at site B occurred within the target, falling short of the improvement aim. The likelihood of achieving the target was associated with the day of week of ED presentation (<i>p</i> &lt; 0.001), with a lower proportion of patients visiting the ED Wednesday through Friday receiving an appointment within 96&#xa0;h. At all sites, ED mental health volume varied by the day of the week and month (<i>p</i> &lt; 0.001): Saturdays and Sundays and the months of July and August had the lowest volumes.</p> Conclusion <p>While follow-up appointments were utilized by many ED mental health patients, the timeliness aim was not achieved. The greatest challenge to meeting the 96-h target was for patients presenting Wednesday through Friday. Modifying ED follow-up appointment availability to respond to demand is needed to ensure timely follow-up.</p>

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Provision of timely follow-up and understanding service demand for pediatric emergency department patients with a mental health concern: a quality improvement initiative

  • 期刊论文

  • 发表日期：

    2026年7月11日

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  • Jocelyn Shulhan-Kilroy,
  • Stephen B. Freedman,
  • Amanda S. Newton,
  • Robert Porter,
  • Laurence Y. Katz,
  • Jennifer Thull-Freedman

摘要

Objectives

To provide mental health follow-up appointments within 96 h of emergency department (ED) discharge to 100% of eligible pediatric patients within one year of implementation and describe demand patterns for ED mental health presentations.

Methods

Two Canadian pediatric EDs implemented an urgent mental health follow-up appointment process for discharged children who lacked existing access to a mental health provider. Six additional sites contributed data to evaluate visit volume patterns. The arrival date for mental health presentations at all 8 sites was collected, as were date and time of discharge and follow-up appointment for sites A and B. The primary outcome, proportion of appointments meeting the 96-h aim, was calculated for every ten consecutive patients and displayed as a p-chart. Association between aim achievement and day of week was assessed using a chi-square test of independence. For all sites, proportion of ED visits by day of week and month were compared using a chi-square goodness of fit test.

Results

Four hundred and thirty-one children were given a follow-up appointment. 75% of appointments at site A and 62% at site B occurred within the target, falling short of the improvement aim. The likelihood of achieving the target was associated with the day of week of ED presentation (p < 0.001), with a lower proportion of patients visiting the ED Wednesday through Friday receiving an appointment within 96 h. At all sites, ED mental health volume varied by the day of the week and month (p < 0.001): Saturdays and Sundays and the months of July and August had the lowest volumes.

Conclusion

While follow-up appointments were utilized by many ED mental health patients, the timeliness aim was not achieved. The greatest challenge to meeting the 96-h target was for patients presenting Wednesday through Friday. Modifying ED follow-up appointment availability to respond to demand is needed to ensure timely follow-up.