ER being taken over by behavioral health patients

Specialties Emergency

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Specializes in general surgery/ER/PACU.

I work in a large ER that has an 8 bed behavioral health locked unit where BH patient's are held until being admited to the 2nd floor psych unit. They are to be evaluated by a psychiatrist withing 16 hours of coming to the ER so that complete orders can be written. ALL patient's (and I mean ALL) that have any complaint of suicidal ideations gets a 1 on 1 sitter. Usually the sitter is a tech that gets pulled from an assignment in the ER to sit with these patients:angryfire I was doing charge one day last week and we were holding 18 BH patient's in our ER because psych was full!! It seems that the patient's have learned that if they come to the ER and say "I think I might kill myself" that they automatically get a room and a sitter to keep them company to make sure that don't hang themselves with a gown! I don't mean to sound harsh....but I am extremely frustrated.

There are 2 other BH/detox facilities in our area also that stay full, so transfers to other facilities is only an option about half of the time.

Is anyone else having this problem? Management is still "looking into a solution":icon_roll

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Specializes in Geriatrics.

The same thing happens in the ED of the hospital I currently have clincials in. A BH patient will come in with suicidal ideations, and will always have a sitter nearby. Most of the time the pt. will be cooperative so they can get the heck out of there.. Which makes me wonder why they always return with the same ideation. Many times they are moved into the hallways to provide an open room for patients with medical emergencies. It always takes time for the psych consult to come by, and the patient can get restless, which is a pain in the butt.

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I work as a mental health tech in the ER, and what we have is four "psych" rooms (bolted down benches, no outlets, blank walls, lockable doors, etc) and my job is to stay right by the psych rooms anytime there is a patient in them. That way I am able to help keep them calm, check vitals, etc and the nurse is a bit more free to move about the ER and do their job. We also, however, have a security officer assigned just to the ER and they often "camp out" in my area. All these extra eyes really help. We have an inpatient psych unit but I'm not sure how many beds it has; I'm thinking about 30....different types of beds for different types of patients. Besides the mental health tech, there are only one or two other techs on at any given time (a tech I, who is a CNA, and a tech II, who is an EMT or paramedic who can help with blood draws and IV starts). I can't imagine pulling them to be 1:1 sitters!

Is there a "mental health tech" position in your ER? Is that something that management might consider creating? It really works quite well here; the nurses work wonderfully with me and the rest of the staff so that we can keep everyone safe and calm and in their rooms to the best of our ability. I have only been in this position for just under a year, but I guess a while back there wasn't a designated tech and they created the position after trying a trial run where they realized (surprise) that it really makes things run more smoothly.

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Specializes in Gyn/STD clinic tech.

i live in charlotte, nc..

we have a "psychiatric emergency department", not actually in the hospital, but a free standing bh center.

the psych er is open 24/7, has a sliding scale fee program, and they do not require upfront payment.

perhaps creating a specialized psych er would be an idea.

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Specializes in psych, addictions, hospice, education.

I hope the OP isn't saying psych patients should stay out of your ER or that they don't need to be watched. I hope the OP is saying the system just needs an overhaul. I'm not fond of the patients looking for "three hots and a cot" but that in itself is a tremendous problem...imagine being willing to be in the hospital in order to get a meal and shelter?

That being said, if your emergency department requires 1:1 for suicidal patients (and it should--imagine what might happen if someone succeeded in suicide while there--it DOES happen!), it seems the management needs to develop a new plan so everyone can get the care that's needed. How about psych nurses or social workers evaluating patients, calling the psychiatrist or talking to the ER doctor, and getting the psych patients admitted more quickly? I did that job in an ER for a long time. Lots of places have such a nurse. It keeps the psychiatrist from having to come inand seems to be very helpful.

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"cowpoke rn" Do you live in florida? The ER you discribed sounds EXACTLY like the ER at the hospital I work at. Even the floor the psych unit is on.

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Specializes in OR.

yeah that coud be very frustrating and scary ... but really where else could they go???/

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...I'm not fond of the patients looking for "three hots and a cot" but that in itself is a tremendous problem...imagine being willing to be in the hospital in order to get a meal and shelter?

I know this may be hard to believe, but for many, the situation on the street is SO bad, even jail shares this same appeal...3 hots, shower, security, clothing, healthcare, cable TV, etc etc...

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Specializes in Med/Surg Cystic Fibrosis Gero/Psych.

At every charge meeting I go to after the start of the shift, the ER talks allot about they're BH patients. They are always filling up beds.

Maybe we should start a suicide hotline or something...

As far as saying "I want to kill myself", wow, that works huh? I'll remember that for myself later.

Anyway, I would prolly be tempted to ask them "Do you mean today?", but never would.

I think allot of them are either looking for meds, looking for a place to eat/sleep and are casualties of our economy/healthcare system. And yes, they know the key things to say because they are in there so often....

Maybe if we just stick them in a real mental institution with REAL crazy people they will get better.... hahahaha, make'em a ward of the state and suggest ECT.

OH GOD! I've become NURSE RATCHET!!!

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Specializes in general surgery/ER/PACU.

Hey RN2B84. No, I live in NC. It's crazy though isn't it! Thanks.

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Specializes in general surgery/ER/PACU.

Thanks DManAZRN! I like you idea the best! LOL!

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Specializes in general surgery/ER/PACU.
I hope the OP isn't saying psych patients should stay out of your ER or that they don't need to be watched. I hope the OP is saying the system just needs an overhaul. I'm not fond of the patients looking for "three hots and a cot" but that in itself is a tremendous problem...imagine being willing to be in the hospital in order to get a meal and shelter?

That being said, if your emergency department requires 1:1 for suicidal patients (and it should--imagine what might happen if someone succeeded in suicide while there--it DOES happen!), it seems the management needs to develop a new plan so everyone can get the care that's needed. How about psych nurses or social workers evaluating patients, calling the psychiatrist or talking to the ER doctor, and getting the psych patients admitted more quickly? I did that job in an ER for a long time. Lots of places have such a nurse. It keeps the psychiatrist from having to come inand seems to be very helpful.

I absolutely want to help the patient's who truly need help if they are considering suicide. I don't want to help the same john/jane does who are at the ER 2 or 3 times a week who act like they are reading from a script and already have their bags packed because they want to stay like it's a hotel. And when they don't get what they want they simply lash out and go on rampages creating a unsafe environment for me. That's my frustration, but thatnks for your thoughts and ideas.

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