<p><strong>INTRODUCTION: </strong>Mental health follow-up after an emergency department (ED) visit for suicide ideation/attempt is a critical component of suicide prevention for young people.</p>

<p><strong>METHODS: </strong>We analyzed 2009-2012 Medicaid Analytic Extract for 62,139 treat-and-release ED visits and 30,312 ED-to-hospital admissions for suicide ideation/attempt among patients ages 6- to 17-years. We used mixed-effects logistic regression models to examine associations between patients' healthcare utilization prior to the ED visit and likelihood of completing a 30-day mental health follow-up visit.</p>

<p><strong>RESULTS: </strong>Overall, for treat-and-release ED visits, 49% had a 30-day follow-up mental health visit, and for ED-to-hospital admissions, 67% had a 30-day follow-up mental health visit. Having a mental health visit in the 30-days preceding the ED visit was the strongest predictor of completing a mental health follow-up visit (ED treat-and-release: adjusted odds ratio [AOR] 11.01; 95% Confidence interval [CI] 9.82-12.35; ED-to-hospital AOR 4.60; 95%CI 3.16-6.68). Among those with no mental health visit in the 30-days preceding the ED visit, only 25% had an ambulatory mental health follow-up visit. Having a general healthcare visit in the 30-days preceding the ED visit had a much smaller association with completing a mental health follow-up visit (ED treat-and-release: AOR 1.17; 95%CI 1.09-1.24; ED-to-hospital AOR 1.25; 95%CI 1.17-1.34).</p>

<p><strong>CONCLUSIONS: </strong>Young people without an existing source of ambulatory mental health care have low rates of mental health follow up after an ED visit for suicide ideation or attempt, and opportunities exist to improve mental health follow up for youth with recent general healthcare visits.</p>

<p><strong>BACKGROUND: </strong>The pediatric intensive care unit (PICU), with limited number of beds and resource-intensive services, is a key component of patient flow. Because the PICU is a crossroads for many patients, transfer or discharge delays can negatively impact a patient's clinical status and efficiency.</p>

<p><strong>OBJECTIVE: </strong>The objective of this study was to describe, using direct observation, PICU bed utilization.</p>

<p><strong>METHODS: </strong>We conducted a real-time, prospective observational study in a convenience sample of days in the PICU of an urban, tertiary-care children's hospital.</p>

<p><strong>RESULTS: </strong>Among 824 observed hours, 19,887 bed-hours were recorded, with 82% being for critical care services and 18% for non-critical care services. Fourteen activities accounted for 95% of bed-hours. Among 200 hours when the PICU was at full capacity, 75% of the time included at least 1 bed that was used for non-critical care services; 37% of the time at least 2 beds. The mean waiting time for a floor bed assignment was 9 hours (median, 5.5 hours) and accounted for 4.62% of all bed-hours observed.</p>

<p><strong>CONCLUSIONS: </strong>The PICU delivered critical care services most of the time, but periods of non-critical care services represented a significant amount of time. In particular, periods with no bed available for new patients were associated with at least 1 or more PICU beds being used for non-critical care activities. The method should be reproducible in other settings to learn more about the structure and processes of care and patient flow and to make improvements.</p>