Psychiatric Boarding Hospitalizations for Children With Autism in a Children's Hospital System.

This study looked at hospital stays for autistic children with mental health needs across different hospital sites. Researchers found that hospitals with better mental health resources had fewer staff injuries during these stays (22% vs 42%). However, the use of physical restraints was similar at all hospitals. Most children (80%) were able to go home after an average 6-day stay, suggesting that with proper support, many can avoid longer-term inpatient care.

This retrospective cohort study examined psychiatric boarding hospitalizations for 174 children with autism across a children's hospital system from 2020-2024, totaling 347 hospitalizations. The study compared outcomes between a main campus with enhanced psychiatric resources (77% of cases) and community campuses with limited resources (23%). Children had a median age of 13 years, were predominantly male (72%), and stayed a median of 6 days with 80% discharged to outpatient care. The main campus demonstrated significantly lower staff injury rates compared to community campuses (22% vs 42%, P=0.02), though physical restraint use did not differ significantly between settings.

Enhanced psychiatric resources in pediatric hospitals may reduce staff injuries during autism-related psychiatric boarding, though restraint use remains unchanged. These findings suggest targeted resource allocation could improve safety outcomes while highlighting the need for comprehensive restraint reduction strategies across all hospital settings.

Single hospital system limits generalizability. Retrospective design prevents causal inferences. No comparison with neurotypical children. Staff injury and restraint definitions not clearly specified. Potential confounding factors between campus types not fully controlled.

Children with autism spectrum disorder (ASD) are more likely to be hospitalized for psychiatric disorders than their neurotypical peers. Hospitalized children with ASD are at higher risk of experiencing agitation and physical restraint use. We aimed to compare the demographics and outcomes of psychiatric boarding hospitalizations for children with ASD between 1 main campus with enhanced psychiatric resources and 2 community campuses with limited psychiatric resources in the same children's hospital system. We conducted a retrospective cohort study of children with ASD hospitalized for psychiatric boarding and referred to psychiatry and psychology services across a children's hospital system between October 2020 and September 2024.

Patients' ASD diagnosis and medical clearance were verified during psychology evaluation. During the 4-year period, 174 children with ASD experienced 347 psychiatric boarding hospitalizations across the hospital system, of which 77% were at the main campus and 23% at community campuses. The patients' median age was 13 years (IQR, 11-16) and 72% were male. The median length of stay was 6 days (IQR, 4-11), with 80% discharged to an outpatient setting.

Staff injury incidence was significantly lower at the main campus than at community campuses (22% vs 42%; P = .02), but physical restraint incidence did not differ significantly between campuses. Staff injuries were significantly less frequent during psychiatric boarding hospitalizations for children with ASD at the main campus with enhanced resources, but physical restraint use was not. Future research should further examine the relationship between ASD care models and safety outcomes across diverse pediatric inpatient settings.