Using patient journey mapping and provider workflows to understand process barriers to pediatric mental and behavioral health care in emergency departments

With the rise in mental and behavioral health (MBH) conditions among school-age children in the United States (US), the number of Emergency Department (ED) visits have also increased. However, ED settings struggle to meet the needs of children with MBH conditions safely and efficiently. This study integrated SEIPS (Systems Engineering Initiative for Patient Safety) 3.0 and 2.0 frameworks to explore the temporal and non-linear aspects of pediatric MBH patients' journey and work processes (professional, patient, and collaborative work) to identify process barriers to pediatric MBH care in the ED. This mixed-method, multiple case study used observations, staff interviews, and time stamps of patient visits from electronic medical records at four EDs in the south-eastern US to inform the integrated patient journey and staff workflow process maps. Most barriers identified related to "medical and psychiatric evaluations" and "disposition and treatment plan" segments of the patient journey, suggesting potential points for interventions.