Views Series: Emergency Psychiatry Consults

OVERVIEW

Overview

Approximately 1 in 8 visits to the ED in the U.S. involve a mental or substance abuse disorder.1 Thus, it is important to consider the needs of patients who present with psychiatric emergencies. Dr. Caylon Pettis, a psych resident at the Mayo Clinic of Rochester, gives his insight on managing patients following his time on the Emergency Psychiatry Consult service. Tune in for a great conversation with D’Monte TP Farley, MD!

Discussion

• Intersection between ED and psychiatry
• History of increased psychiatric presentations to the ED

Part 1

• EM Psych Consult Team
• Team
• Scope of practice
• Discussion on determining factors for  inpatient hospitalization
• Three Tenants
• “What type of patient am I dealing with?” ASSESSING OUR PATIENT
• Agitation, substance use, WHAT’S THE BIGGER ISSUE?
• exacerbating/protective factors
• Discussion surrounding “holds” on patients and what goes into that decision.

Part 2:

• Patient case that stood out during time on emergency psych rotation.

• What was the approach?
• What was the outcome?

Part 3:

• A general conversation surrounding disposition

• Connecting with other services to help plan discharge decisions
• Overall management of psych patients from a more hands-on perspective

Part 4:

• Capacity & Competence

• The difference between the two terms

• Capacity is fluid
• Competence is legal

Part 5:

• Tips/Closing Remarks from a psych resident
• Assessing for SI/HI
• Determining foul play from potential substance use?
• Access to firearms?
• Takeaways from emergency psychiatric consult service
• Importance of communication amongst interdisciplinary teams
• Comfortability in seeing various presentations in emergency/psychiatric patients
• Using agitation meds early (before patient gets overtly agitated)

References

1. Weiss AJ, Barrett ML, Heslin KC, Stocks C. Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006–2013. HCUP Statistical Brief #216. December 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb216-Mental-Substance-Use-Disorder-ED-VisitTrends.pdf. 
2. Zun L. Care of Psychiatric Patients: The Challenge to Emergency Physicians. West J Emerg Med. 2016;17(2):173-176.