Experience Talks

Abstract

We are lucky enough to have a psychiatric emergency evaluation center within our institution with a psychiatry residency program. Patients who present with purely psychiatric concerns are seen briefly in triage to ensure that they do not have a medical problem that would preclude an accurate mental health evaluation and to ensure that they have not tried to harm themselves in any way. Once that is done, they are escorted by a tech and security to the locked psychiatric evaluation center. Our problems arise when a patient has both a psychiatric problem and a medical problem. Most of these patients are immediately brought to a room, placed on 1:1 direct observation for safety and suicide risk, and then asked to disrobe entirely for medical evaluation. One of our emergency medicine attendings then makes an assessment to evaluate the patient's safety to see if the 1:1 observation is still needed. It would be ideal to have the patient seen shortly thereafter by someone from psychiatry so that the patient's medical and psychiatric problems could be addressed simultaneously. Unfortunately, because the psychiatry department is not part of our unit and there is one psychiatrist available, this usually does not happen. On occasion, a patient who is going to be admitted for medical reasons may have his or her psychiatric evaluation initiated in the department by the psychiatrist. The usual procedure is to have the patient stabilized from a medical perspective and then sent to the psychiatrist in the locked psychiatric center after discharge. Problems with this have arisen when the psychiatrist wants to institute an involuntary admission but staff members who saw the initial presentation are no longer present or, after stabilization, the patient now refuses psychiatric evaluation.—Christian Burchill, PhD, RN, CEN, Clinical Level IV, Hospital of the University of Pennsylvania, Philadelphia, PA; E-mail: [email protected]