Harbor:Transferring to psych ER

Guidelines for Flow of patients between the Psychiatric and Adult Emergency Departments (ED Policy 3.4)

  • Ambulatory Patients: Patients presenting with abnormal behavior WITHOUT prior psych diagnoses or with acute ALOC are initially evaluated in the adult ED
  • Patients with a known psych history and behavior consistent with their previous diagnosis, without apparent acute medical condition requiring intervention, are initially evaluated by the Psych ED
  • Patients arriving by ambulance with psych complaints but not under a 5150 should be triaged by a physician in the adult ED then directed to appropriate location
  • Psychiatric Consultations in the ED: patients requesting voluntary evaluation by a psychiatrist are transferred to the psych ED after medical clearance for evaluation and should be transferred to the psych ED as soon as there is space available; ED physician to psych physician discussion should occur prior to transfer
  • All patients on a 5150 hold
  1. With ETOH>200, delirium, complicated alcohol withdrawal, drug overdose, or acute medical problems should be evaluated in the adult ED
  2. Require psych evaluation prior to discharge or transfer to medical unit; this should be done within 30 minutes of request for consult
  • Patients in the psych ED that require medical evaluation (or re-evaluation) should be transferred to the adult ED as soon as a bed is available; prior to the transfer, the psych physician should discuss the case with the ED physician; exceptions will be made on a case-by-case basis
  • PAGE 4 of POLICY: Patients in the Psychiatric ED who may require treatment with sedating medications and are deemed to be at risk for significant oxygen desaturation when sedated, based on clinical evidence, should be transferred to a monitored bed in the ED. Open policy on DHS computer or remote desktop Link the ED Policy 3.4
      • Examples of clinical evidence include a credible history of significant obstructive sleep apnea (OSA) or witnessed apnea, hypoxia, or desaturation when sleeping after treatment with sedating medications.
      • Transfers to the ED from the Psychiatric ED for concerns about OSA should be based on physician clinical judgment, and not solely on body mass index. These patients are co-managed by the physicians from both areas.
  • Psychiatric patients with chronic disorders who require placement are managed in the Psych ED

Approved June 2015, Chappell 2/22/16

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