Harbor:PED psych patients - Revision history

Bchap23: /* Exodus */

2020-06-16T20:30:46Z

Exodus

← Older revision		Revision as of 20:30, 16 June 2020
Line 49:		Line 49:
	*PED physicians should order outside time for patients, and make sure they are having access to a shower at least every other day		*PED physicians should order outside time for patients, and make sure they are having access to a shower at least every other day

	==Exodus==		==Exodus for PED==
	*Patients are eligible for evaluation at Exodus if:		*Patients are eligible for evaluation at Exodus if:
	**Age 12 years or older		**Age 12 years or older

Kyoung: /* Is the patient seen in PED or Psych ED? */

2018-05-25T12:15:13Z

Is the patient seen in PED or Psych ED?

← Older revision		Revision as of 12:15, 25 May 2018
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	*Age		*Age
	**Patients age 12 to 17 years may be seen in the new adolescent psychiatry unit		**Patients age 12 to 17 years may be seen in the new adolescent psychiatry unit
	**~~Patients age 15 years or less~~ should ~~be seen in~~ PED, ~~with~~ psychiatry ~~consulted~~		***Perform an MSE exam and then patient may go with only nurse to nurse communication if medically cleared
	***If a patient is particularly aggressive or ~~an elopement risk, they~~ may be ~~transferred to Psych~~ ED ~~after consultation with Psychiatry~~		***Patient should have no medical issues that require PED evaluation, and should be able to be separate from parent / caretaker
	**~~Patients age 16 years and above can receive a screening~~ MSE ~~in triage~~ and then ~~be sent~~ to ~~Psych~~ ED ~~in some cases~~		***Adolescent psychiatry unit nursing station x1930, docbox x2444
	***~~Patient should have no medical issues that require PED evaluation~~		**Patients age 18 or over may be seen in psychiatry ED
	***If on a 5585 or 5150 hold, EMS or police willing to wait with patient outside the Psych ED until patient can be brought back		***Perform an MSE exam and then patient may go to adult psych ED with only nurse to nurse communication if medically cleared
	***If brought in voluntary with family, PED physician ascertains that patient is safe to wait outside Psych ED with family and unlikely to leave without being seen		***Adult Psychiatry ED nursing station x3144, docbox x4082
	****Patients ~~and family may also~~ be ~~referred directly to Exodus if appropriate (see below)~~		***If on a 5585 or 5150 hold and being taken to adult psychiatry ED, EMS or police willing to wait with patient outside the Psych ED until patient can be brought back
	***~~For anyone at high~~ risk ~~of an acute mental health issue~~, ~~it is best~~ to ~~keep them in the PED unless the~~ Psych ED ~~is able to take them directly back~~		***If brought in voluntary with family and being taken to adult psychiatry ED, PED physician ascertains that patient is safe to wait outside Psych ED with family and unlikely to leave without being seen
			**Patients age 11 years or less should be seen in PED, with psychiatry consulted
			***If a patient is particularly aggressive or an elopement risk, they may be transferred to adolescent Psych ED after consultation with Psychiatry
	****Discuss with Psych ED physician to physician		****Discuss with Psych ED physician to physician
	**Patients ~~age < 18 years cannot be roomed with patients aged 18~~ and ~~older in the Psych ED, so the Psych ED~~ may ~~not~~ be ~~able~~ to ~~accommodate them immediately~~		**Patients and family may also be referred directly to Exodus if appropriate (see below)
	*Chief complaint and past mental health history		*Chief complaint and past mental health history
	**Some patients meeting age criteria to go to the psych ED, but being seen for newer onset eg depression or suicidality may not be good candidates for being seen in the Psych ED		**Some patients meeting age criteria to go to the psych ED, but being seen for newer onset eg depression or suicidality may not be good candidates for being seen in the Psych ED
	**Conversely, some younger patients normally kept in PED may have previous history of severe aggression or elopement requiring them to be seen in Psych ED		**Conversely, some younger patients normally kept in PED may have previous history of severe aggression or elopement requiring them to be seen in adol Psych ED

	==PED practitioner evaluation and orders==		==PED practitioner evaluation and orders==

Kyoung: /* Psychiatry consultation */

2018-05-25T12:07:34Z

Psychiatry consultation

← Older revision		Revision as of 12:07, 25 May 2018
Line 27:		Line 27:
	==Psychiatry consultation==		==Psychiatry consultation==
	*Monday through Friday, non-holidays, daytime hours, the Child Psych fellow will consult		*Monday through Friday, non-holidays, daytime hours, the Child Psych fellow will consult
			**Spectra phones: before 4pm 23831, after 4pm 23822; adult ED consult 24/7 spectra 23822
			**Dr. Kelly 23829, Dr. Borlik 23830
	**Call schedule is either posted on the bulletin board or available on MedHub		**Call schedule is either posted on the bulletin board or available on MedHub
	*Other times, the Psych ED resident will consult		*Other times, the Psych ED resident will consult

Kyoung: /* Is the patient seen in PED or Psych ED? */

2018-04-20T23:45:51Z

Is the patient seen in PED or Psych ED?

← Older revision		Revision as of 23:45, 20 April 2018
Line 1:		Line 1:
	==Is the patient seen in PED or Psych ED?==		==Is the patient seen in PED or Psych ED?==
	*Age		*Age
			**Patients age 12 to 17 years may be seen in the new adolescent psychiatry unit
	**Patients age 15 years or less should be seen in PED, with psychiatry consulted		**Patients age 15 years or less should be seen in PED, with psychiatry consulted
	***If a patient is particularly aggressive or an elopement risk, they may be transferred to Psych ED after consultation with Psychiatry		***If a patient is particularly aggressive or an elopement risk, they may be transferred to Psych ED after consultation with Psychiatry

Mholtz: Text replacement - "prn" to "PRN"

2017-07-07T10:33:33Z

Text replacement - "prn" to "PRN"

← Older revision		Revision as of 10:33, 7 July 2017
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	*Psychiatry should put in their consult note any medications that need to be continued or initiated, ''including'' the dose		*Psychiatry should put in their consult note any medications that need to be continued or initiated, ''including'' the dose
	**The PED team will place the actual orders for the medications in Cerner		**The PED team will place the actual orders for the medications in Cerner
	*Psychiatry should also put in their consult note preferred ~~prn~~ medications in the case of patient agitation		*Psychiatry should also put in their consult note preferred PRN medications in the case of patient agitation
	*PED physicians should order outside time for patients, and make sure they are having access to a shower at least every other day		*PED physicians should order outside time for patients, and make sure they are having access to a shower at least every other day

Kyoung at 22:51, 21 April 2017

2017-04-21T22:51:00Z

← Older revision		Revision as of 22:51, 21 April 2017
Line 1:		Line 1:
			==Is the patient seen in PED or Psych ED?==
			*Age
			**Patients age 15 years or less should be seen in PED, with psychiatry consulted
			***If a patient is particularly aggressive or an elopement risk, they may be transferred to Psych ED after consultation with Psychiatry
			**Patients age 16 years and above can receive a screening MSE in triage and then be sent to Psych ED in some cases
			***Patient should have no medical issues that require PED evaluation
			***If on a 5585 or 5150 hold, EMS or police willing to wait with patient outside the Psych ED until patient can be brought back
			***If brought in voluntary with family, PED physician ascertains that patient is safe to wait outside Psych ED with family and unlikely to leave without being seen
			****Patients and family may also be referred directly to Exodus if appropriate (see below)
			***For anyone at high risk of an acute mental health issue, it is best to keep them in the PED unless the Psych ED is able to take them directly back
			****Discuss with Psych ED physician to physician
			**Patients age < 18 years cannot be roomed with patients aged 18 and older in the Psych ED, so the Psych ED may not be able to accommodate them immediately
			*Chief complaint and past mental health history
			**Some patients meeting age criteria to go to the psych ED, but being seen for newer onset eg depression or suicidality may not be good candidates for being seen in the Psych ED
			**Conversely, some younger patients normally kept in PED may have previous history of severe aggression or elopement requiring them to be seen in Psych ED

			==PED practitioner evaluation and orders==
			*Perform a medical screening exam to ensure there are no non-psychiatric complaints or disorders that need medical attention
			*If the patient is on a 5585 (< 18 years) or 5150 involuntary hold, order the hold in Cerner
			**Enter the date and time the hold was placed (found on the hold paper)
			**Enter the reason for the hold (danger to self, danger to others, gravely disabled)
			**Choose "continue" as we are not instigating the hold, merely continuing it
			*Order regular diet, vital signs q shift, 1:1 observation, Consult to ED Psych (this puts a P on the track and puts the patient visible on Psych ED track)
			**Consider ordering a urine pregnancy test and urine toxicology screen as indicated

			==Psychiatry consultation==
			*Monday through Friday, non-holidays, daytime hours, the Child Psych fellow will consult
			**Call schedule is either posted on the bulletin board or available on MedHub
			*Other times, the Psych ED resident will consult
			*Department of Psychiatry has committed to providing initial consultation within 4 hours of patient arrival
			*After initial evaluation, sometimes patients will be held in the PED for a period of time to gain additional collateral information from caretakers
			**If a patient arrives in the evening or night, this period of time may last until the next morning
			**Patients should not be in the PED > 12 hours without a disposition
			*Disposition will be either safe for discharge with outpatient follow-up or bed search for admission to a psychiatric facility
			**Psychiatry consultant should put in an order for Bed Search, and a B should be visible on the track
			**If discharging, Psychiatry consultant should discontinue any 5585 or 5150 hold

			==Ongoing care of patients in PED==
			*Sometimes patients are in the PED for a prolonged period of time awaiting transfer to a psychiatric facility
			*The PED team is caring for the patients, with Psychiatry as consultants
			*Psychiatry should put in their consult note any medications that need to be continued or initiated, ''including'' the dose
			**The PED team will place the actual orders for the medications in Cerner
			*Psychiatry should also put in their consult note preferred prn medications in the case of patient agitation
			*PED physicians should order outside time for patients, and make sure they are having access to a shower at least every other day

			==Exodus==
			*Patients are eligible for evaluation at Exodus if:
			**Age 12 years or older
			**Not in juvenile justice or law enforcement custody
			**Do not have severe autism or mental retardation
			**Have Medi-Cal insurance or no insurance (cannot have private insurance)
			*They may be already on a 5585 or 5150 hold, or may be voluntary
			*Exodus intake number 800-829-3923
			*Transport to Exodus if accepted
			**If on a hold, call 562-295-4617 for county transport
			**If voluntary, can send with parent if safe
			***Else, can consult Harbor Psychiatry to place a hold for transport by county transport

	==See Also==		==See Also==

Rossdonaldson1: Created page with " ==See Also== *Harbor:Pediatric ED (main) Category:Admin"

2017-04-21T22:04:36Z

Created page with " ==See Also== *Harbor:Pediatric ED (main) Category:Admin"

New page

==See Also==
*[[Harbor:Pediatric ED (main)]]

[[Category:Admin]]