Contributor: Aaron Lessen, MD

Educational Pearls:

• Patients with psychiatric complaints are often complicated to disposition from the main ED, and many will require inpatient psychiatric stays
• Some health systems have dedicated psychiatric ED's that are specialized in taking care of these patients
• For example, in Oakland, CA, EMS are permitted to "clear" a patient for transport to a psych-only facility.
• 5-year retrospective study of this system showed 40% of psych patients were cleared by EMS for transfer directly to a psychiatric facility
  • Only 0.3% of these patients "bounced back" and required an emergency department visit
• This technique could be used elsewhere to provide the most appropriate care for psych patients

References

Trivedi TK, Glenn M, Hern G, Schriger DL, Sporer KA. Emergency Medical Services Use Among Patients Receiving Involuntary Psychiatric Holds and the Safety of an Out-of-Hospital Screening Protocol to "Medically Clear" Psychiatric Emergencies in the Field, 2011 to 2016. Ann Emerg Med. 2019 Jan;73(1):42-51. doi: 10.1016/j.annemergmed.2018.08.422. Epub 2018 Sep 28. PubMed PMID: 30274946.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD