P2.109: Mental and behavioral health crises in the pediatric ICU: An integrative literature review

Background: As rates of psychiatric disorders increase and safety nets unravel, pediatric intensive care units (PICU) face many more admissions complicated by mental and behavioral health crises (MBHC). Managing these patients in high acuity medical environments is challenging for providers who often have limited psychiatric training. This integrative literature review aims to construct initial frameworks around PICU MBHC and help develop potential solutions for improved care.

Methods: English language articles pertaining to “pediatric psychiatric boarding” were identified in MEDLINE. Backward and forward snowballing techniques were then conducted. Quantitative and qualitative articles, reviews, and commentaries were considered. Articles were divided into six communities of practice (CoP): emergency medicine, pediatric hospitalist medicine, inpatient psychiatry, critical care medicine, community and public health, and participant viewpoints. The most evocative articles from each were selected. Data were analyzed and synthesized into emergent themes.

Results: Of 397 sampled articles, 96 were included for in-depth review. Four overarching themes emerged: i) PICU teams require a common vocabulary to effectively communicate about MBHC with specialists and each other; ii) PICU MBHC lead to the collision of dysregulated people, within dysregulating environments; iii) major gaps in evidence-based recommendations for MBHC exist; and iv) potential solutions may be combined into diverse PICU MBHC toolkits. (Table 1)

Conclusion: PICU MBHC present a unique challenge. Solutions for personalized and compassionate care in the PICU exist and demand further exploration.