INDEX

Psych Patients

Table of Contents:

• Patient Cap (Overnight)

• Fast Track Protocol

• Unclear Dispositions (Psych Consults)

• Psych Admissions

• Attending Contact List

• Stable for Discharge

• Psych Transfers

• Pediatric Psych Patients

• Employee Referrals

• Bradford Referral from GED

• SUD Management

Cross References:

• Opiates

• Restraints

• COVID-19

• From 23:00-08:00, the night call resident will have a cap of 7 new patient evaluations (which includes PES consults, admissions to CPM, or stat inpatient consults.)

• After the resident has reached the cap, any new patients beyond the cap will be handed off to the day PES team.

• After reaching the cap, the resident will still be available to handle emergent cross-cover needs with boarded patients who are admitted to psychiatry, as well as to provide guidance in managing agitation in new patients who have not yet been formally evaluated. In these cases, the resident will provide recommendations but will not write an H&P or place orders.

• With some psych patients, it may be difficult to assess whether a patient needs inpatient psychiatric admission or is OK for outpatient management.

• In these cases, ED physicians may request formal psych physician consultation where the psychiatrist comes down to the ED or performs a tele-psych consult, leaves a note and aids with disposition.

• ED physicians will directly page the PES Provider on-call (pager #8333) and specify that they are requesting a consult to aid with disposition.

• ED physicians need to place the order called "UED Consult to Psych". Please right-click and complete this order when the consult is concluded.

ED physicians must first ensure that the patient is medically cleared and this includes having the psych medical clearance labs back. See below for more details regarding medical clearance.

• ED physicians will directly page the PES Provider on-call (pager #8333) and specify that they have a psych patient that needs admission.

• ED physicians do NOT need to formally order a psych consult if the admission is immediately accepted.

• In general, Dr. Peter Penherski is the default attending for CPM admissions.

In cases where the attending is needed but normal paging methods are not working, the following contact list can be used.

• ED physicians may perform their own assessments and deem a patient stable for discharge without needing any ED-based psych resources.

• ED physicians may request the help of PES nurses and/or PES social workers to help with outpatient planning.

• Per CMS, when we have no psych beds at UAB, patients who do not have capacity do not need to give consent to be transferred to another facility.

• This includes patients who present voluntarily with suicidal ideation.

• For pediatric patients, follow the standard process for all psych MD consultations after medical clearance by paging the PES Provider on-call.

In the event that an employee is referred by their supervisor to the ED for psychiatric evaluation, there is a specific policy and procedure to follow.

• Bradford provides emergency consultations for ED patients needing inpatient or outpatient addiction programs/resources.

• They provide services for both adults and adolescents. They try to make it to the ED within 1-2 hours of the consultation.

Contact Bradford at: 800-217-2849 (Maria Cameron is primary contact for GED)

• This is a flowchart for management of patients with primary substance complaints.

KEYWORDS: psych, psychiatry, mental health, CPM