Abstract
OBJECTIVE: Youths experiencing a behavioral health crisis often have a long length of stay (LOS) in emergency departments (EDs) and on inpatient psychiatric units, with myriad negative consequences. This scoping review aimed to identify interventions that decrease LOS in these acute care settings and to characterize helpful practices. METHODS: MEDLINE, Embase, PsycInfo, and Web of Science were systematically searched. Peer-reviewed empirical articles that described interventions to decrease LOS in acute care hospitals for youths (up to age 18) with behavioral health concerns were included. Two screeners from a group of four independently reviewed each study, determined study eligibility, and extracted data. RESULTS: Twenty-eight articles met inclusion criteria. Studies were primarily evaluated through same-setting pre-post designs and conducted in the United States. Interventions to address LOS in EDs and on inpatient psychiatric units included assessment protocols, adjustments to the continuum of care available to youths, disorder-specific clinical pathways, personnel restructuring, structural changes, technology implementation, evidence-informed treatments, and multiple strategies. Although no singular model for helpful intervention emerged, several categories of interventions had encouraging results. CONCLUSIONS: Reducing LOS in acute care settings is a burgeoning area of research and is critically important given the ongoing youth behavioral health crisis. Continued research should prioritize rigorous study design, consistent reporting, the inclusion of representative samples, and intervention scalability.