Keep Safe While Boarding Psychiatric Patients in the Emergency Department

As with all of our patients, it is vital to treat and address those who suffer from acute psychiatric illness with compassion and respect.

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ACEP Now: Vol 40 – No 04 – April 2021

Multidisciplinary Approach

Although this project was a quality/operations program in a high-volume emergency department with a large number of psychiatric patients, given the relative rarity of self-harm in the ED setting, the study may not have been sufficiently powered (ie, large enough to detect a statistical change) for us to reach definitive conclusions about the efficacy of the specific intervention that was evaluated. Also, many emergency departments may not have access to 24-hour in-house psychiatric consultation or an on-site liaison. Therefore, some of the proposed interventions might not be feasible in all practice settings.

However, the study does represent an important contribution to our understanding of management strategies for the boarding psychiatric patient, and some of its broad takeaways might be applicable to a wide breadth of practice settings. First, similar to the approach to scene safety in field assessment for EMS workers, emergency physicians should consider and mitigate any potential opportunities for self-harm or harm to others for patients with acute psychiatric illness. Second, early coordination and conversation with mental health specialists are important, particularly when the search for placement for psychiatric patients requiring inpatient psychiatric hospitalization may be a prolonged process. Lastly, as with all of our patients, it is vital to treat and address those who suffer from acute psychiatric illness with compassion and respect.

Although patient satisfaction data were not collected in this study, future work involving all key stakeholders, including the patients themselves, may shed light on which aspects of the acute care experience most minimize adverse behavioral effects and improve outcomes in the emergent setting. Behavioral and psychiatric emergencies continue to represent some of the most challenging clinical cases. A multidisciplinary approach focused on patient safety and harm reduction represents a promising and innovative approach that can lead to improved patient care and positive health outcomes, ensuring the safety of this vulnerable group of patients.

Dr. Chang is vice chair of research and associate professor of emergency medicine in the department of emergency medicine at Columbia University in New York City.