Pitfalls in the Care of the Psychiatric Patient in the ED
Background: Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.
Objective: The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.
Discussion: The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.
Conclusions: Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.
Emergency Physicians (EPs) frequently care for mental health patients in the Emergency Department (ED). EDs across the country see a large number of psychiatric patients. Larkin and others reported that there were 53 million mental-health-related visits in 2001 (1). That number represents an increase of 4.9–6.3% of all ED visits from 1992 to 2001, primarily from non-Hispanic Whites, the elderly, and those with insurance. The most frequent diagnoses found in the study were substance-use disorders (22%), mood disorders (17%), and anxiety-related disorders (16%). Treatment was provided in the ED in 61% of those seen with psychiatric illness. The ED is also being used for pediatric psychiatric emergencies. Sills and Bland found that 1.6% of all ED patients in the pediatric age group had a psychiatric complaint. Most of these children were non-white, teenage, female, and lived in the Northeast or Midwest. The most frequent pediatric diagnoses in this study were substance use (24.2%), anxiety (16.6%), attention deficit and disruptive disorders (11.3%), and psychosis (10.8%). Medications were given in 47.1% of these patients, and 19.4% of these patients were admitted.
Just like other patients with non-psychiatric illnesses seen in the ED, it is important for EPs to understand and address the pitfalls of caring for patients with psychiatric illnesses. This article presents many of the pitfalls in the care of mental health patients in the ED. The article will address the burden of the psychiatric patient, staff attitudes, the medical clearance process, treatment of agitation, suicidal patients, and admission decisions. This manuscript is not a risk-management treatise and will not describe medico-legal concerns of psychiatric patients.
Abstract and Introduction
Abstract
Background: Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.
Objective: The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.
Discussion: The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.
Conclusions: Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.
Introduction
Emergency Physicians (EPs) frequently care for mental health patients in the Emergency Department (ED). EDs across the country see a large number of psychiatric patients. Larkin and others reported that there were 53 million mental-health-related visits in 2001 (1). That number represents an increase of 4.9–6.3% of all ED visits from 1992 to 2001, primarily from non-Hispanic Whites, the elderly, and those with insurance. The most frequent diagnoses found in the study were substance-use disorders (22%), mood disorders (17%), and anxiety-related disorders (16%). Treatment was provided in the ED in 61% of those seen with psychiatric illness. The ED is also being used for pediatric psychiatric emergencies. Sills and Bland found that 1.6% of all ED patients in the pediatric age group had a psychiatric complaint. Most of these children were non-white, teenage, female, and lived in the Northeast or Midwest. The most frequent pediatric diagnoses in this study were substance use (24.2%), anxiety (16.6%), attention deficit and disruptive disorders (11.3%), and psychosis (10.8%). Medications were given in 47.1% of these patients, and 19.4% of these patients were admitted.
Just like other patients with non-psychiatric illnesses seen in the ED, it is important for EPs to understand and address the pitfalls of caring for patients with psychiatric illnesses. This article presents many of the pitfalls in the care of mental health patients in the ED. The article will address the burden of the psychiatric patient, staff attitudes, the medical clearance process, treatment of agitation, suicidal patients, and admission decisions. This manuscript is not a risk-management treatise and will not describe medico-legal concerns of psychiatric patients.
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