Evidence map›Paper›PMID 40165260›Full record

Trial reportBMC health services research2025

Improving transitions in care for children and youth with mental health concerns: implementation and evaluation of an emergency department mental health clinical pathway.

Alexandra Tucci, Paula Cloutier, Christine Polihronis, Allison Kennedy, Roger Zemek, Clare Gray, Sarah Reid, Kathleen Pajer, William Gardner, Nicholas Barrowman and 2 more

Registry-linked trialAbstract readClinical TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02590302 (Improving Transitions in Care for Children and Youth With Mental Health Concerns), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02590302 naunknown statusnot on this map

Improving Transitions in Care for Children and Youth With Mental Health Concerns: Implementation and Evaluation of an Emergency Department Mental Health Clinical Pathway

TypeinterventionalSponsorChildren's Hospital of Eastern OntarioRan2017 to 2019Enrolled3,095ConditionsMental HealthArmsImplementation Phase
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Family Factors and Repeat Pediatric Emergency Department Visits for Mental Health: A Retrospective Cohort Study.Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Alexandra TucciChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
Paula CloutierChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
Christine PolihronisChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
Allison KennedyChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
Roger ZemekChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
Clare GrayChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
Sarah ReidChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
Kathleen PajerChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
William GardnerChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
Nicholas BarrowmanChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
Mario CappelliChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.
Mona JabbourChildren's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada. jabbour@cheo.on.ca.

Funding

CIHR 337794
6 · The paper itself

Abstract

backgroundEmergency departments (EDs) are often the first access point for children and youth seeking mental health (MH) and addiction care. However, many EDs are unprepared to manage large volumes of pediatric MH patients. In addition, the fragmented Canadian MH system is challenged in connecting youth seen in the ED for follow-up community services. A provincial Emergency Department Mental Health Clinical Pathway (EDMHCP) for children and youth presenting to the ED with MH concerns was developed to address these challenges. The objective of the current study was to determine if EDMHCP implementation resulted in: (1) pathway use, (2) more patients discharged with MH recommendations, (3) MH service recommendations that aligned with patients' risk assessments, and (4) changes in service outcomes, including ED length of stay (LOS), revisits, and admissions/transfers.

methodsWe implemented the pathway at four ED sites from 2018 to 2019 using the Theoretical Domains Framework to develop a tailored strategy at each site. We conducted chart reviews retrospectively in 2017-2018 (pre-implementation) and prospectively in 2019-2020 (post-implementation). Non-parametric tests examined differences in service outcomes between the implementation periods.

resultsPathway use varied widely across sites, ranging from 3.1% at site 4 to 83.0% at the lead site (site 2). More referrals to community MH agencies (p <.001) were made at discharge during post-implementation at the lead site compared to pre-implementation, and mixed results were obtained regarding whether clinicians' risk assessments aligned with MH service recommendations. LOS significantly increased at the lead site (p <.001) and non-lead sites (sites 1, 3, 4; p =.02) between pre- and post-implementation. Revisits and admissions/transfers did not change significantly at any site.

conclusionImplementation was partially successful at the lead site, showing high pathway use and greater referrals to community MH agencies. These findings emphasize the complexity of implementing pathways in various ED settings. Successful implementation requires integration into existing workflows.

trial registrationClinicalTrials.gov (NCT02590302). Registered on 29 October 2015.

Indexed as

Critical PathwaysEmergency Service, HospitalMental DisordersMental Health ServicesAdolescentCanadaChildFemaleHumansLength of StayMalePatient DischargeQuality ImprovementRetrospective StudiesClinical pathwayEmergency departmentImplementationMental healthPediatric

Identifiers

PMID40165260
PMCPMC11956442

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.