Abstract
Purpose of Review
Disposition decisions of psychiatric patients in the emergency department are challenging in hospitals without rapid access to psychiatric professionals. There is a movement towards more outpatient management of psychiatric patients in response to inpatient bed shortages and more appropriate use of resources. If there were a good modality of risk assessment for suicidal patients, then it would be possible that the ER physician could discharge more patients home following evaluation. These options would allow for better throughout and less cost incurred by the patient and healthcare system.
Recent Findings
Currently, the severity of psychiatric illness (SPI) and crisis triage rating scale (CTRS) are not reliable modalities of risk stratifying psychiatric patients. More research and training are needed on developing quick, reliable ways to stratify these patients thereby not only improving disposition time but also improving care. Patients with new or worsening psychosis or mood disorder must have a thorough psychiatric exam performed. In addition, information from collateral sources should be collected when determining disposition.
Summary
This article reviews the thought process and risk stratification modalities that should be considered when determining disposition selection in emergency rooms without readily available psychiatric services. Although the SPI rating scale and the CTRS provide some guidance in this decision, ER providers should also consider psychosocial factors, collateral information, and judgment.
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References
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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Flynn, S.W., Zun, L.S. Disposition Decisions for Psychiatric Patients Presenting to the Emergency Department. Curr Emerg Hosp Med Rep 5, 103–107 (2017). https://doi.org/10.1007/s40138-017-0133-6
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DOI: https://doi.org/10.1007/s40138-017-0133-6