ED Management – April 1, 2023

New Solutions to Help Young Patients Who Present with Behavioral Health Crises

Behavioral health mobile teams, comprised of psychiatrists, psychologists, experts in autism and developmental disabilities, nurses, social workers, and case managers, can support medical teams caring for patients in crisis.

Novel Unit Accelerates Psychiatric Care, Keeps Patients Flowing

Some departments have designated space where patients with psychiatric emergencies will be taken as soon as they are medically cleared in the ED. Here, they will be evaluated promptly and treated by psychiatric specialists. This model has prevented boarding, opened more beds, made transfers smoother, and produced better outcomes.

Is an EmPATH-Style Unit Right for Your ED?

When deliberating, remember the busy, noisy environment of the ED often makes symptoms worse for patients who have presented with psychiatric emergencies. Many EmPATH units consist of designated open spaces where patients are free to roam while under observation.

Experts Detail Remaining Barriers to Facilitating Evidence-Based Treatment for OUD

A lack of universal education in medical school and residency programs might perpetuate a reluctance to engage, diagnose, treat, and appropriately refer patients with opioid use disorder. Silos that keep substance use treatment outside mainstream healthcare can limit the collaboration and streamlined referral processes needed between EDs and outpatient providers.

Psychiatric Patients Pose Many Legal Risks for EDs; Creative Solutions Needed

Crisis stabilization units, peer support specialists, and targeted screening tools can help leaders fill some gaps.

There Could Be Trouble if Providers Board Children with Psychiatric Complaints

If parents disagree with a hold, convey that staff are keeping the child safe, explain the steps they are taking to find an accepting hospital, and detail how the ED cannot discharge a patient who is on an involuntary hold. When families are informed and given space to vent, the situation can de-escalate.

Restraint Use Can Put Provider, Hospital in a Jam

Personal animus or emotion on the part of an emergency provider should never be a rationale for the use of restraints. EDs are at risk for allegations of unlawful restraint or assault in circumstances where the use of restraints is not justified.

Emergency Clinicians’ Emotional Reactions to Psychiatric Patients Affect Care, Well-Being

Survey participants painted a picture of negative healthcare experiences, for both patients and clinicians, that are adversely affecting the quality of care and staff well-being. Change is badly needed to ensure these vulnerable patient populations receive care — and to support ED providers.

Challenges in Accessing Resources Lead to ED Psychiatry Consults

Difficulty identifying the “right” level of care for patients, understanding how insurance plays a major role in post-ED care options, and needing help with the operational process of making referrals to outside treatment facilities all are administrative and bureaucratic headaches with which clinicians could use assistance.

Facilities Require ‘Medical Clearance,’ But Evidence Suggests It Is Unnecessary

A patient may present with new delusions, but an otherwise normal physical exam. Why keep that person in a regular ED treatment space or hallway for hours while waiting for a CT scan? Instead, this patient can avoid exposure to radiation, be “cleared” for evaluation by an acute care psychiatrist or social worker, and receive access to treatment hours earlier.