Harbor:Transferring to psych ER

Guidelines for Flow of patients between the Psychiatric and Adult Emergency Departments (ED Policy 3.4)

• Ambulatory Patients: Patients presenting with abnormal behavior WITHOUT prior psych diagnoses or with acute ALOC are initially evaluated in the adult ED
• Patients with a known psych history and behavior consistent with their previous diagnosis, without apparent acute medical condition requiring intervention, are initially evaluated by the Psych ED
• Patients arriving by ambulance with psych complaints but not under a 5150 should be triaged by a physician in the adult ED then directed to appropriate location
• Psychiatric Consultations in the ED: patients requesting voluntary evaluation by a psychiatrist are transferred to the psych ED after medical clearance for evaluation and should be transferred to the psych ED as soon as there is space available; ED physician to psych physician discussion should occur prior to transfer
• All patients on a 5150 hold

1. With ETOH>200, delirium, complicated alcohol withdrawal, drug overdose, or acute medical problems should be evaluated in the adult ED
2. Require psych evaluation prior to discharge or transfer to medical unit; this should be done within 30 minutes of request for consult

• Patients in the psych ED that require medical evaluation (or re-evaluation) should be transferred to the adult ED as soon as a bed is available; prior to the transfer, the psych physician should discuss the case with the ED physician; exceptions will be made on a case-by-case basis
• Patients in the Psych ED who require treatment with sedatives and are deemed to be at risk for significant oxygen desaturation should be transferred to a monitored bed in the adult ED; these patients are co-managed by the physicians from both areas
• Psychiatric patients with chronic disorders who require placement are managed in the Psych ED

Approved June 2015, Chappell 2/22/16

See Also

• Harbor:Main