Closing the provider-psych patient information gap

by Jeremy Tucker In the emergency department, psychiatric patients can be particularly challenging. Evaluation in the ED is primarily based on history from many different sources--police, family, EMS, many times second hand or on a written report or petition. Often, family does not accompany the patient to the ED. Patients can be unreliable, intoxicated or just plain unable or unwilling to answer questions. This presents opportunities for "information gaps" to occur for the care team. The medical clearance is fairly routine. You certainly have to be suspicious of intoxication and ingestion. There are a few and not terribly common medical causes for psychiatric presentations that must be considered. Elderly patients may more commonly present with dementia or delirium mimicking psychiatric illness. Once medical clearance is completed, however, determining the proper disposition is the goal. A few years back we had an unexpected outcome with a psychiatric patient that had been discharged from the ED. When we looked into the issues surrounding the care, it mainly centered on communication. We found that different members of the ED team caring for the patient had different pieces of information and may have assumed others knew this information. It is common for many people to interact with the patient, including the bedside sitter, nurse tech, nurse, charge nurse, triage nurse, physician and behavioral health employee who performs the psychiatric evaluation in the ED. ...
Source: hospital impact - Category: Health Managers Authors: Source Type: blogs