Behavioral Health Patients in the ED

[vokaybo]

We are a small rural hospital and have committment patients waiting for placement on a daily basis. Sometimes we have as many as 7 spread all over the hosptial. Some are here for days and even weeks before we can find placement for them. We do not have any kind of pyschiatric units here. Do any of you have policies you are willing to share if you are in a similar situation. We don't know quite what to do with these patients and need help reaching TJC requirements for hosptials that are not psych hospitals.

If you are willing to share, message me back and I will send you my contact information.

[Altra, BSN, RN]

Even in urban areas, psych resources are often spread pretty thin. For a patient to wait for a day or two for an inpatient bed to be found is unfortunately not uncommon.

But "weeks"?? Initial involuntary commitments in my state are 5 days and I recognize that your state may be different ... but for *weeks* to go by ... that has to be considered unacceptable, and an infringement of the patient's legal rights. The patient is being legally confined to undergo psychiatric evaluation/treatment ... but is not receiving any evaluation/treatment.

And what physicians are these patients admitted to, for "weeks"? Who writes their orders for diet, meds, etc.?

Even a very small hospital should have someone who functions in a case management role - I would think that that would be the person to ask about this process and how it might be improved.

[Racer15, BSN, RN]

My hospital contracts with a local mental health organization. They are on call for us 24/7 to come do psych evaluations. As long as a patient is medically cleared, they can make the call to clear them for discharge, or arrange for a psychiatric admission to another facility. We never have psych patients for very long due to this system.