Psychiatric Patient's triaged through ER?

[retro-active]

Is it very common to have a patient with a psychiatric problem, severe depression/ptsd from child abuse, to be told to go to the ER (at a covering hospital) to be triaged and how is the decision made to admit patient to inpatient psych through the hospital vs outpatient programs? Can the patient request inpatient if they have insurance? I work for the state so have almost free insurance.

[jmking]

Is it voluntary or involuntary? Ususally if the patient is having a relapse we send them to the ER. This is from small mental facility that can treat fairly stable patients.

[Altra, BSN, RN]

Yes, this is the typical way that a patient will be admitted to an inpatient psych unit.

[Jelli_Belli]

I work at a free standing inpatient psychiatric facility. We send all of our patient's through the ER at a nearby hospital to be cleared medically before admission. That doesn't mean that they still don't send up people with 2.0 potassium levels or BAL's in the 600's, but at least when something goes wrong, our butts are covered.

[nuangel1, BSN, RN]

Yes, this is the typical way that a patient will be admitted to an inpatient psych unit.

agreed .this usually happens .we have voluntary and involuntary admits in our ed .they get medical clearance in ed first then get psych clinician eval and either of 3 things happen .pt gets admitted as a voluntary ,meaning they can leave,or invol .which means they are admitted for a 72 hr hold as inpt.or pt is deemed in no immediate harm and is disch from ed usualywith outpt follow up.

[retro-active]

agreed .this usually happens .we have voluntary and involuntary admits in our ed .they get medical clearance in ed first then get psych clinician eval and either of 3 things happen .pt gets admitted as a voluntary ,meaning they can leave,or invol .which means they are admitted for a 72 hr hold as inpt.or pt is deemed in no immediate harm and is disch from ed usualywith outpt follow up.

thanks so much to everyone, it helps a lot. what is "psych clinician" exactly, social worker?

[Altra, BSN, RN]

thanks so much to everyone, it helps a lot. what is "psych clinician" exactly, social worker?

At both ERs where I have worked, patients were evaluated by psych RNs. This may well vary from facility to facility, and social workers will probably play a larger role in the event of an involuntary commitment.

[Altra, BSN, RN]

how is the decision made to admit patient to inpatient psych through the hospital vs outpatient programs? Can the patient request inpatient if they have insurance? I work for the state so have almost free insurance.

A couple of points ...

Having insurance, while a good thing, has no bearing on the appropriateness of inpatient admission though it will likely impact where (meaning what facility) a patient is admitted to if he/she is admitted. Admission or referral to outpatient services is a medical decision (remember, psychiatry is a medical specialty.

And about that "free" insurance ... you say you're a state employee and like employees of many governmental units have "good" insurance to which you contribute very little toward the premiums, far less than many of your private sector neighbors. But please be aware -- your insurance premiums i.e. the cost of insuring you is no less than anyone who works in the private sector, and does not entitle you to have medical decisions made for you on a different basis than someone who pays a large portion of their premiums or possibly even the entire cost of coverage, or someone who lacks insurance coverage entirely.

And lastly ... I say this because you included an "I" statement in your first post ... if you are in need of a psychiatric evaluation I would recommend that the closest ER is where you need to be right about now.

Good luck to you.

[retro-active]

hmmm. so a "crisis counselor" who comes into the ER to intreview the patient is a social worker, or just an intake person for psych or something?

[retro-active]

I apologize, I don't believe my comment came out the way I meant it, but it's not important.

[mauxtav8r]

hmmm. so a "crisis counselor" who comes into the ER to intreview the patient is a social worker, or just an intake person for psych or something?

A friend of mine has a job like the one described. She is an RN working for an inpatient psych facility. She and others from her facility travel to area hospitals to triage psych patients. They determine whether the pt. would be appropriately placed in the psych facility or if they be fine in the traditional hospital environment (remembering at this point that many, many med-surg patients have psychiatric conditions that are exacerbated by their medical issues).

[mamalle]

yes- they all come through the ER- either voluntary or under baker act for medical clearance. That goes for the transfers also from other psych facilities to our mental health facility.