Simulation-based evaluation of alternative care pathways and capacity configurations in pediatric mental health emergency care

<p>Pediatric mental and behavioral health visits place growing pressure on emergency departments, where long evaluation times, disposition delays, and extended stays while waiting for placement or discharge increase crowding and resource strain.</p> <p>This study evaluated how alternative care pathways and capacity configurations are likely to affect pediatric emergency department performance for mental and behavioral health care.</p> <p>We developed a discrete-event simulation model of a pediatric emergency department using electronic medical record data, clinician input, and observed workflow.

The model tested five scenario groups: psychiatric emergency unit routing, patient volume growth, disposition-to-departure delay, mental and behavioral health case-mix, and psychiatrist coverage.</p> <p>In the simulated emergency department, psychiatric emergency unit routing reduced time to psychiatric evaluation and space utilization. Reducing disposition-to-departure delays produced the largest improvements in throughput and space utilization, whereas expanded psychiatrist coverage primarily improved outcomes for mental and behavioral health patients, especially length of stay and time to disposition.