Separate area in ED relieves pressure
Separate area in ED relieves pressure
If it is not practical to create a psychiatric ED at your facility, you can create a separate area within your department for psychiatric patients, says Steve Sterner, MD, chief clinical officer and an emergency physician at Hennepin County Medical Center in Minneapolis and chair of a joint American College of Emergency Physicians (ACEP)/Minnesota Medical Association task force evaluating psychiatric bed availability and the boarding of psychiatric patients. In fact, he adds, Hennepin has such an area in addition to a separate psychiatric ED.
"It's an area devoted to intoxicated and incarcerated patients and patients with behavioral problems that allows us to isolate that patient population," he explains. "It is called the special care or 'locked' unit."
Such a unit, he says, requires one or two holding rooms where mental health patients can be placed without the need for physical restraint. "If you have enough volume where you see such patients regularly, then having a separate area where they are cared for in a quieter environment away from the general population makes a lot of sense," says Sterner.
Ideally, he says, such an area should be staffed by people with expertise in mental health. Hennepin has a psychiatrist on duty 24 hours a day, says Sterner. However, if you don't have a full-time psychiatrist, "nurse specialists, social workers, or even nurse practitioners and [physician assistants] with specialized training in mental health can work in these areas as long as you have a supervising doctor, who could be psychiatrist or an ED doc, to provide oversight," he says.
Need for 'second-visit people'
Most ED docs are equipped to deal with these patients initially, says David Mendelson, MD, FACEP, a member of the ACEP Emergency Medicine Practice Committee and chair of its subcommittee on psychiatric and substance abuse; vice president of medical affairs for Dallas-based EmCare, a contract ED staffing company; and a practicing emergency physician. "But we need more second-visit people — specially trained psychiatric counselors, many of whom have nursing backgrounds, who are trained in acute evaluation of psychotic patients," Mendelson says. "We are best at evaluating what needs to be done immediately, but they are trained to determine the next step of treatment."
If it is not practical to create a psychiatric ED at your facility, you can create a separate area within your department for psychiatric patients, says Steve Sterner, MD, chief clinical officer and an emergency physician at Hennepin County Medical Center in Minneapolis and chair of a joint American College of Emergency Physicians (ACEP)/Minnesota Medical Association task force evaluating psychiatric bed availability and the boarding of psychiatric patients.Subscribe Now for Access
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