New psych assessment guidelines

Over the past two years, Virginia ACEP along with the Virginia Hospital and Healthcare Association (VHHA) and the Department of Behavioral Health and Developmental Services (DBHDS) has been working on standardized, cost-effective, and safe guidelines for medical assessment of psychiatric patients. These guidelines go into effect on Nov. 5.

This collaborative guideline will help streamline the medical assessment, as well as reduce costs and time needed to help take care of patients presenting with psychiatric emergencies. These guidelines were established with the welfare of patients foremost in mind.

KEY points of the guidelines

  • Healthy patients less than 60 years old only need an alcohol, urine drug screen, and a urine pregnancy test (if appropriate).
  • Adult patients with alcohol intoxication must have an alcohol level of less than 250 mg/dL AND be clinically sober to be accepted.
  • Pediatric patients above 12 years get a UDS and UPT (if female of childbearing age). Those less than 12 years only need a UPT (if female of childbearing age).
  • If there are disagreements in testing needed prior to admission, a direct communication between an ED physician and Psychiatrist is required.
  • There is an escalation pathway if disagreement persists.
  • If there is disagreement about a toxicological case, the Toxicologist from poison control is the consultant to help decide what medical assessment is needed (as per Virginia code).
  • Patients who have capacity to make informed decisions and do not consent to collection of a urine/blood specimen will not be forced, including under an ECO.
  • These guidelines will be reviewed on an ongoing basis.

The Guidelines

Visit the DBHDS page for more information on the guidelines.

If you have questions or comments, please reach out to:
Joran Sequeira, MD | Board of Directors and Fellow, VACEP |