Behavioral Health ED Visit: Expectations and Limitations

 

CME CREDIT NOW AVAILABLE-1.0 AMA PRA Category 1 Credit FOR EACH ISSUE (2 ARTICLES)!!!!!!

By: Kristin Weinschenk, MD and Michael Lowley, MD

Kristin.Weinschenk@choa.org

The primary goal of the psychiatric evaluation in an ED setting is to assess the safety of the individual, and to connect them with resources at the appropriate level of care. This begins at triage with a screening tool called the ASQ (Ask Suicide-Screening Questions to Everyone in Medical Setting), a five-item questionnaire which flags patients for risk of recent or current thoughts of self-harm. A positive screen will then trigger referral for amore detailed evaluation by either the psychiatric social worker in the ED, or by a member of the Psychiatry Consult Liaison service. The MH professional will conduct a psychosocial assessment, and complete a more detailed suicide risk assessment tool called the BSSA. Once level of risk is established, the treatment plan will reflect the need for appropriate safety and monitoring, whether at an inpatient psychiatric hospital or in a less restrictive care setting.

 

(SCROLL TO END OF ARTICLE TO APPLY FOR CME CREDIT, READ BOTH POST BEFORE CLICKING ON LINK)

 

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CHOA EMERGENCY DEPARTMENT EVALUATIONS OF PSYCHIATRIC ILLNESS

 

Swathi Khrishna sakris2@emory.edu

Sonali Bora Sonali.bora@choa.org

Many primary care providers are on the front lines of fielding questions and identifying symptoms of psychiatric illness in children and adolescents in the community setting.  We have put together a quick guide that addresses some common questions and concerns on how to refer non-emergent psychiatric concerns to community outpatient resources and avoid unnecessary and costly ED visits

What kind of services are and are not available to children with psychiatric/behavioral complaints in the ED?

Psychiatric assessments in the medical ED setting are brief and focused.  They are not full psychiatric evaluations and are not meant to provide new diagnosis or start new medications.   They are simply a crisis assessment to evaluate for the child’s safety and the safety of others. If a patient is deemed unsafe to self or others, they will be transferred to a primary psychiatric facility for further treatment.  It is an assumption of many community providers that patients with psychiatric complaints must first be directed to a medical facility for “medical clearance”.  In fact, all psychiatric facilities are emergency receiving facilities and have the resources to provide medical clearance and directly accept healthy patients with behavioral and psychiatric complaints.  Most psychiatric hospitals perform psychiatric assessments 24/7,  and can place a patient on a 1013 or admit them voluntarily. Psychiatric facilities can also refer families to outpatient or lower levels of care if inpatient psychiatric hospitalization is not warranted. PLEASE NOTE CHOA DOES NOT HAVE INPATIENT PSYCHIATRY SERVICES.

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