By Stacey Kusterbeck
Many EDs routinely board mental health patients for days on end, awaiting transfer to a mental health facility. It is easy for emergency care providers to develop an “out of sight, out of mind” attitude toward these patients.
“Make no mistake about it: These patients are the emergency physician’s responsibility, even after the medical clearance is complete and they are awaiting placement,” warns Gary W. Tamkin, MD, FACEP, vice president of provider development at US Acute Care Solutions, a national ED and hospitalist staffing company based in Canton, OH.
To alleviate safety and medical/legal risks, Tamkin recommends emergency physicians (EPs) take these steps:
• Carefully follow the hospital’s medical clearance protocol for mental health patients;
• Obtain psychiatric consultation as early as possible, and promptly initiate any new medications that are recommended;
• Immediately restart the patient’s psychiatric medications if they have been medically noncompliant; in addition, restart the patient’s medications for chronic illness. “There is nothing more frustrating than finally obtaining a psychiatric placement only to have it canceled because the patent’s hypertension or diabetes is poorly controlled,” Tamkin notes.
• Formally round on the boarded mental health patient, and document this in a formal behavioral health progress note in the medical record. “Be sure to address any medical issues, changes in behavior, or additional orders,” Tamkin says.
This will ensure the mental health patient is receiving continual care.
“It will also document ongoing involvement with this high-risk patient, should there be a poor outcome,” Tamkin adds.
• If the high-risk mental health patient is cleared by psychiatry to return home, but the EP still expresses safety concerns, then he or she should formally contact the psychiatric consultant to convey those concerns — and document the conversation.
The EP can do this in a non-confrontational way. Simply clarify specific details of the history that in the EP’s opinion make the patient high risk for returning home.
In Tamkin’s experience, the psychiatric consultant often will change their recommendation and decide to hold a patient instead, in light of the EP’s voiced concerns. “If the consultant continues to deem the patient safe for discharge, your concerns will be carefully documented and help to protect you legally should there be a poor outcome,” Tamkin says.
Many EDs routinely board mental health patients for days on end, awaiting transfer to a mental health facility. An expert offers tips to help emergency medicine providers alleviate safety and medical/legal risks.
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