Virginia’s Medical Assessment and Screening Guidelines

Virginia has a protocol, established in 2018 by the Department of Behavioral Health and Developmental Services, that standardizes the Medical Assessment and Screening process for psychiatric admissions from emergency departments. The protocol serves two key purposes:

• Removes the need for blanket testing on patients experiencing mental health crises

• Reinforces state law allowing for Provider-to-Provider consultation between an Emergency Physician or Advanced Practice Providers (APPs) in the ED where a psychiatric patient is taken and the admitting Psychiatrist at any private hospital, state hospital, or crisis stabilization unit

UPDATE, January 2025: The Guidelines’ Protocol Review and Monitoring Committee (PRMC) has made several updates to the guidelines. The updated documents are linked above; the revisions are as follows:

• “Doc-to-Doc” references are now “Provider-to-Provider” to allow emergency department advance practice providers (APPs) to have conversations with family medicine physicians or psychiatric nurse practitioners doing patient acceptances.

• Any request for further testing is to automatically transition to Provider-to-Provider communication

• Dispute resolution is to include Community Services Board/Behavioral Health clinician workflow for Provider-to-Provider escalation

• If a PA or NP at a sending ED is the provider primarily managing the patient in the ED, or a PA or NP at a receiving facility is the one primarily reviewing medical evaluations for acceptance, they may be substituted in place of a physician or doctor. If requested, either the sending or accepting facility can ask to speak with the physician on-call. 

Read the 2018 Joint Memorandum and get more information on the guidelines. These were developed over two years by a workgroup with representatives from DBHDS, VACEP, and the Virginia Hospital & Healthcare Association (VHHA). In addition, feedback was sought from multiple behavioral health stakeholders throughout Virginia, including the Virginia Association of Community Services Boards.

This August 2024 webinar hosted by VACEP provides guidance to the Commonwealth's ER docs, admitting psychiatrists, and Community Services Boards regarding:

• The importance of proper emergency department documentation to avoid blanket testing on patients experiencing a psychiatric crisis

• What psychiatrists and CSBs need to hear to earn trust and reassurance from emergency physicians

• What Virginia law says about Provider-to-Provider (formerly Doc-to-Doc) communication in times of discrepancy

Presenters:

• Joran Sequeira, MD | President-Elect, VACEP

• Steve Crossman, MD | Family Physician, Central State Hospital 

Provider-to-Provider: It’s the law.

If there are disagreements regarding assessment and screening needed prior to psychiatric admission, an Emergency Physician or provider can request a direct communication with the admitting Psychiatrist or other care provider. This is allowed by state law and outlined in the Code of Virginia, § 32.1-127.

FAQs

We’ve compiled a list of frequently asked questions on the Guidelines.

REPORT ISSUES

If you are an emergency physician who has faced issues or has questions on this process, VACEP needs to know in order to share with the Protocol Review and Monitoring Committee (PRMC). Are you getting Doc-to-Doc calls (allowed by state law) when asked? Where are the barriers? Are hospitals still requiring unnecessary testing?

Contact VACEP’s Joran Sequeira, MD, FACEP or Bruce Lo, MD, FACEP. Both played key roles in the development of these guidelines and serve on the PRMC.