Psych patients in ED

[smirn80]

Our hospital is in the process of starting psych RNs to work in the ED to care for psychiatric patients. This will not be a full psych ED, but ED expanding its services to alleviate the backflow of psychiatric patients waiting in the ED. I am hoping to get some feedback here. We have done some research already, looked at Illinois Best Practice, but would like some feedback from those that already have this implemented, or perhaps have tried others, and can share their success/challenges. In addition, anyone willing to share Job Descriptions would be greatly appreciated, as we haven't found anything specific out there (I work in a unionized environment, and some concerns have already been raised about what these Psych RNs would be doing when there are no psych patients to care for during their shift).

Ultimate goal is to provide the same quality (or very similar) treatment for the psych patients outside of the Behavioral Health Unit, especially for those that have to wait in the ED for acute psych admissions.

Thank you.

Sherwin Imperio, MSN, RN-BC, PHN

[emtb2rn, BSN, RN, EMT-B]

Is there a psychiatrist involved?

Will the psych unit/area be separate from the main er & secured (i.e., locked doors)?

Will there be psych screeners available to determine if pt suicidal/homicidal, voluntary/involuntary prior to psychiatrist seeing pt? Not all psych pts are really psych pts.

Will there be dedicated security?

Answers to all of the above should be yes. There is more, including suicide screens and standing orders for psych pts, but that's the start.

[NurseOnAMotorcycle, ASN, RN]

Where I work there is all of that except locked doors or 24 psychologist for our normal patient load. If we have any concern about a "psych" patient, we automatically put a security 1:1 watch on them.

It sounds more like their department should actively recruit and train psych nurses for emergency work rather than have a dedicated psych section and hope the nurses can do critical care as well.

[Rhi007]

We (RAH) have what is called PECU as well as 3 mental health rooms in the diagnostics area. PECU has a registered psych nurse there at all times and it only holds 4 patients.

[bubblejet50]

I do not currently work in a facility likd you are saying but have done clinical in an er with a psych holding unit. It was separate, had about 7 rooms that had doors that were see through. The staff were psych nurses but if they didnt have any patients they helped with the main er load. They could hold someone in this er unit for an unlimited timr until a room on the psych floor opened up.