Jason09 Posted May 26, 2012 Share Posted May 26, 2012 What's your thoughts on patients with suicidal ideation or suicide attempt in relation to management in the ER? I have worked in a couple of places that this was a mandatory hold and transfer to a psych facility. I am currently working in a place where a social worker comes and evaluates the psych patient and makes the decision if the patient is deemed to meet psych facility admission. I am very nervous about this as I had a patient last week who voiced suicidal ideation and wanting to harm himself and the social worker said he should be d/c and they will f/u as an office visit type thing outpatiently. They did get a "don't kill yourself contract" signed but I am wondering how this will hold up in court when one of these patients kills themselves? How do you all manage these type of patients? Link to comment Share on other sites More sharing options...
KMD16 Posted May 26, 2012 Share Posted May 26, 2012 What's your thoughts on patients with suicidal ideation or suicide attempt in relation to management in the ER? I have worked in a couple of places that this was a mandatory hold and transfer to a psych facility. I am currently working in a place where a social worker comes and evaluates the psych patient and makes the decision if the patient is deemed to meet psych facility admission. I am very nervous about this as I had a patient last week who voiced suicidal ideation and wanting to harm himself and the social worker said he should be d/c and they will f/u as an office visit type thing outpatiently. They did get a "don't kill yourself contract" signed but I am wondering how this will hold up in court when one of these patients kills themselves? How do you all manage these type of patients? A mandatory hold/psych consult NOT a social worker. Will sign-off on pt when psych shows up and I would let them take it from there. I would walk away as fast as I can when psych at the scene. Don't forget to document the heck out of your encounter and clearly stating the names of the psychiatrist that took over the case in the pt's chart. When in doubt, ask your superior. Having the pt sign " don't kill yourself contract" I haven't heard of it. Your best bet would be to talk to a lawyer. Follow your gut! Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted May 26, 2012 Moderator Share Posted May 26, 2012 In Pennsylvania it's a mandatory 72-hour hold with transfer to a psych facility (which no doubt is exploited by homeless coming in wanting "three hots and a cot" saying they're suicidal), so not much of an issue here. When I was an ER tech in Texas before PA school, they had a situation similar to what you described- a psych social worker showed up who did an evaluation, but I think they also did consult with a psychiatrist over the phone, but not sure Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 26, 2012 Administrator Share Posted May 26, 2012 If your attending wants to let it go with a social worker say-so vs. psych consult/hold, make sure it's HIS name on the chart, not yours, and scupulously document that you deferred the decision to your SP. Link to comment Share on other sites More sharing options...
mackjacks Posted May 26, 2012 Share Posted May 26, 2012 The ED I work in has it's own Psych emergency service that pts can walk into, also any SI/SA pt treated in the med ED must go over for evaluation. It's especially nice when a pt presents to psych ED after ingesting who knows what or other self-injury and they can be brought over to med ED to be cleared before psych eval. The Psych ED has a lot more calming environment and everything is discreetly bolted down, it's really nice. Link to comment Share on other sites More sharing options...
medic25 Posted May 27, 2012 Share Posted May 27, 2012 Contracts for safety are not uncommon in the management of patients presenting with suicidal ideation, although I don't think there is a lot of literature to support their efficacy. http://www.ncbi.nlm.nih.gov/pubmed/10370451 I've got it easy because my ED has a separate psychiatric ED staffed 24/7 by psychiatry. Our SI patients either go directly back to see them, or if they have to come see us for medical clearance first (e.g. physical complaint, advanced age) we see them and then go back to see the psychiatrists. Link to comment Share on other sites More sharing options...
Jason09 Posted May 27, 2012 Author Share Posted May 27, 2012 Thanks for all the input. I am actively trying to get the hospital to address this issues as I think this puts WAY to much liability on us in the ED. Link to comment Share on other sites More sharing options...
Contrarian Posted May 27, 2012 Share Posted May 27, 2012 Nope... No more Liability than anywhere else. Failure to DOCUMENT properly then notify psych services is where you liability lies. Do those two things and you are golden. "Contracts for Safety" have been around for decades. Concisely DOCUMENT, hand-off, slowly back-away...and let the grown-ups handle it. Link to comment Share on other sites More sharing options...
Jason09 Posted May 27, 2012 Author Share Posted May 27, 2012 I wish I could "hand-off" the patient but I am the one who has to discharge. The social worker comes and writes a little note on them and they recommend admission or not. They don't take over the patient but punt it back to me to discharge. So I am the one who ultimately has to discharge. I am just unfamiliar with this process as I have always had a mandatory admission option and hand-off available. Link to comment Share on other sites More sharing options...
brookspa Posted May 27, 2012 Share Posted May 27, 2012 In GA, PAs can sign 10-13s ( 72 hr hold for eval by psych) that being said, the reality is a shortage of beds and facilities. dont even get me started on adolescents and children. Hospital policy and procedure is the rule. And yes social workers trained as a Crisis Response Team (CRT) person can and does interview the patient or reviews all labs and interviews the PA oor Nurse per telephone and then presents to the Psych Dr. They are then accepted or not. Thats the end of it. you can chase your tail for days looking for a bed but if thed do not meet criteria , your feelings dont matter. Do what you have to to feel good but know that at the end of the day, the system is the system. Document, use the correct language and speak clearly and directly to whomever you speak with. Dont bee cool or coy. contrarian again is pretty much on target as well. Lousy system all over..huge abuse of all of us and psych. Few real suicide threats...much drama. i have seen more than my share of each, Link to comment Share on other sites More sharing options...
Contrarian Posted May 27, 2012 Share Posted May 27, 2012 I wish I could "hand-off" the patient but I am the one who has to discharge. The social worker comes and writes a little note on them and they recommend admission or not. They don't take over the patient but punt it back to me to discharge. So I am the one who ultimately has to discharge. I am just unfamiliar with this process as I have always had a mandatory admission option and hand-off available. Again... Still don't see the problem. Just like EVERY other discharge/disposition that you do/sign off on... based upon recommendations from specialists (Ortho, Surg, Rheum, OB, ENT, Gyn, etc) ... you get consults (psych in this case), then thouroughly DOCUMENT your rational for your actions/inactions. In a nutshell: Documenting- 'this is what I saw... I called in the experts... they examined the patient... and made these recommendations... I'm gonna defer to the experts... and do what they recommend.' No different than any other specialist consult. But then again... I Practice Internal Medicine and Psychiatry daily in a involuntary setting. I teach Psychiatry/Behavioral Medicine to PA students in both inpatient and outpatient settings. I round in the Crisis center and the Social Detox center. I interact daily with interdiciplinary crisis workers/teams so its all "old hat' to me... Again... the key for you is DOCUMENTATION. Who What When Where Why How... Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.