Behavioral Health Emergencies in the Emergency Department

From Urgent Matters:

The lack of consensus regarding all aspects of this issue is astounding, but ultimately it comes down to two things: time and money. If patients complaining of new onset psychiatric complaints, with no other previous medical history, are evaluated the same as patients with a history of psychiatric complaints, substance abuse, or extensive co-morbidities, is it necessary to be “treated” in the ED? In my humble opinion, our healthcare system should develop a standardized protocol, which can compromise between both sides of this argument. If a patient presents with psychiatric symptoms, they should be examined as any other patient with a routine physical exam and obtaining a detailed medical history. If the patient has stable vitals, normal physical exam, no substance abuse (altered mental status) and no other complaints- the complaint could potentially be evaluated directly by psychiatrists or within a psychiatric-focused ED, as many hospitals have this already. For patients deemed a higher risk, such as elderly patients, patients with new onset psychiatric symptoms and patients with altered mental status, testing should be determined based on each patient’s presentation and medical necessity, and by the treating ED physician.

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