EC holds from other facilities

mmc51264, BSN, MSN, RN · Apr 22, 2016

Forgive me, but what is an "EC" hold?

NanaPoo · Apr 22, 2016

EC=enteric coated

oceancaldera207 · Apr 22, 2016

It's only a Colorado thing apparently. I always assumed it stood for emergency care hold. At my facility I see three types of holds; M1, EC, and something they call a Colorado hold/per CO law. It's my understanding that in most states there's only one type of hold.

It seems to me that EC holds are put in place when the person is primarily a medical/trauma patient but is for some reason not considered competent to make the decision to go AMA. M1s seem to be for SI/HI/pure psych pts. As for CO holds...no idea what criteria brings this about, or how it differs from the EC holds.

HouTx, BSN, MSN, EdD · Apr 22, 2016

This is above our pay grade..... your organization's legal team should be developing the P&P to follow.

elkpark · Apr 22, 2016

From the context, I would guess that "EC" means "emergency commitment," but that's just a guess. OP, as I always say in response to questions like this, this is why your facility pays big bucks to have legal counsel available. What does your hospital legal department say? Has someone asked them?

oceancaldera207 · Apr 23, 2016

No, no guidelines established by legal dept that I know of. It's incredible to me considering the quantity of people that end up on holds in our ER. I get the feeling that in order to keep things in a grey area for us in the trenches, there won't be any clear directives handed down until some major lawsuit occurs.

elkpark · Apr 23, 2016

No, no guidelines established by legal dept that I know of. It's incredible to me considering the quantity of people that end up on holds in our ER. I get the feeling that in order to keep things in a grey area for us in the trenches, there won't be any clear directives handed down until some major lawsuit occurs.

Have those of you "in the trenches" asked? Have you made noise to your superiors about the problem and needing direction?? That's what I would be doing (have done in similar situations).

Editorial Team / Moderator · Apr 23, 2016

In Virginia, EC meant "emergency custody," we called it an Emergency Custody Order (ECO). This must be reescalated to your legal department. It's a very difficult issue. We used to insist that law enforcement remain with the patients until we decided on a 72-hour psych hold that would be issued by our physician (it was a Temporary Detention Order, or TDO). At the point a patient was under a TDO, the facility had responsibility but we would call law enforcement if the patients successfully eloped. Personally I rarely get between the patient and the door. I am 4'11" and I am not scared to scrap with someone, but I am realistic. Lol.

Psych in the ED always seems to be a hot mess unless you have a psych ED or a psych pod in your ED.

oceancaldera207 · Apr 23, 2016

Have those of you "in the trenches" asked? Have you made noise to your superiors about the problem and needing direction?? That's what I would be doing (have done in similar situations).

That's the thing..everyone has a different idea of what should be done, and mostly they are extremely evasive and do not give clear answers. My fear is that the law is so vague that no one is actually right. From what I've seen of the statutes, there seems to be a lot of situations that aren't really addressed.

oceancaldera207 · Apr 23, 2016

In Virginia, EC meant "emergency custody," we called it an Emergency Custody Order (ECO). This must be reescalated to your legal department. It's a very difficult issue. We used to insist that law enforcement remain with the patients until we decided on a 72-hour psych hold that would be issued by our physician (it was a Temporary Detention Order, or TDO). At the point a patient was under a TDO, the facility had responsibility but we would call law enforcement if the patients successfully eloped. Personally I rarely get between the patient and the door. I am 4'11" and I am not scared to scrap with someone, but I am realistic. Lol.
Psych in the ED always seems to be a hot mess unless you have a psych ED or a psych pod in your ED.

That's really interesting about your facility's LE policy ! Over here, all the officer has to do is call a psych liaison and give them a run down of what occurred that brought them to the facility, then they usually bolt. And almost every day LE cuts and runs on people with warrants if it's going to take more than an hour to medically clear them. It's our understanding that it's a HIPPA violation to let LE know when a patient is discharged unless that person is an imminent threat/danger to society. But that's a whole other can of worms!

But yeah, we do have a psych pod, but it's very small and it often overflows. Unfortunately our psych pod is full of EtOHers and meth withdrawals because our city's system for handling these issues is ridiculously under funded and ignored.

I wanted to respond a bit more but I have to run for the moment, thanks for your reply! It's definitely a touchy issue, appreciate any input from experience!

elkpark · Apr 23, 2016

That's the thing..everyone has a different idea of what should be done, and mostly they are extremely evasive and do not give clear answers. My fear is that the law is so vague that no one is actually right. From what I've seen of the statutes, there seems to be a lot of situations that aren't really addressed.

Who is "everyone"? Again, the reason your employer has a legal department and risk management department (and pays a lot of money to have them) is so that they can examine the relevant statutes and case law, consult with the state authorities as needed, and sort out precisely what the law says and what the facility's responsibilities and liabilities are in regard to these clients. It's not a matter of individual clinical or administrative people debating what they think the law says or what the hospital should be doing; there is an answer.