One of the most common complaints that I hear from Emergency Physicians around Wisconsin is the difficulty in medically clearing patients for admission to outside psychiatric facilities. Sometimes EM docs are being asked to get serial labs for minute electrolyte abnormalities, or prolonged observation for non-toxic overdoses. This leads to delays in transfer, prolonged ED stays, agitated patients, and exasperated ED staff.
WACEP has been a part of a joint task force with Wisconsin Psychiatric Association (WPA) to help address issues germane to both our specialties. While emergency physicians struggle on one end of the transfer, every inpatient psychiatrist can share stories of a patient who decompensates shortly after arrival at their facility, so they are appropriately wary.
At the end of the day, we all want to do what is best for patients. It is imperative that we provide a thorough evaluation and appropriately diagnose and treat any comorbid medical issues in the ED prior to transfer, but what to do when you feel your due diligence has been done and you are getting pushback you feel is inappropriate?
Often the first screener for admission is a nurse or APP, and many of these requests for additional workup come from a lack of medical understanding and an abundance of caution. The psychiatrists have encouraged us to ask to speak directly to the psychiatrist on-call for a given facility if you feel that further workup is not warranted. In particular, Dr. Pope, Medical Director at Winnebago, endorses this approach.
WACEP and WPA hope that this will help to alleviate unnecessary delays, and still ensure safe hand-off of patients between EDs and psychiatric facilities.