The Two Objectives During Every Psychiatric-Type Complaint

* Medical Clearance* Psychiatric Risk Assessment

Medical Clearance

* Required by EMTALA to perform a “screening exam” regardless of complaint* Most psychiatric facilities have poor diagnostic/treatment capabilities for non-psychiatric conditions and will want patient to be “medically cleared”* Sometimes they will require specific tests to be performed, blood pressure to be treated, etc* My “medical clearance” order set includes* Electrolytes* CBC* Serum Alcohol* Urine Drug Screen (UDS)* Pregnancy (if appropriate)* Tylenol/Salicylate Levels (especially if suicidal)* Psychiatric patients frequently have other non-psychiatric emergencies* Overdoses (salicylate, acetaminophen, etc)* Trauma (alcoholics with subdural hematoma from falls)* Encephalopathy (hypoglycemia, encephalitis)

Psychiatric Risk Assessment

* Will this patient truly put themself or others at risk if sent home due to mental health?* Do you need to involuntarily hold patient? * Are they having passive thoughts of being dead or true INTENT and PLAN to harm themself? * Did they name a specific person/group of people that they intend to harm?

Additional Reading

* State Laws on Involuntary Mental Health Holds (Psychiatry Online)