Medical Assessment Guideline Reminders for Psychiatric Patients
Reminder on direct doc-to-doc communication for inpatient psychiatric care (Medical Screening Guidelines)
We've gotten some questions lately on protocol for patients having a psychiatric episode. As emergency physicians, it is our job is to make sure the patient doesn’t need medical treatment or admission and is safe to be transferred to a psychiatric institution.
Important to Know: In the event a state or private hospital that provides inpatient psychiatric services refuses to admit a medically stable patient to its psych unit, Virginia law requires direct verbal communication, when requested by the referring physician, between the on-call physician in the psychiatric unit and the referring physician (see section 20 in Virginia Code 32.1-127. Regulations.) If you have questions or have experienced issues that need to be escalated, let us know.
Background: In November 2018, newly established Medical Assessment and Screening Guidelines went into effect in Virginia. The Guidelines outline a protocol for providing inpatient psychiatric services, and were developed through a Workgroup made up of representatives from VACEP, the Department of Behavioral Health and Developmental Services (DBHDS), and the Virginia Hospital & Healthcare Association (VHHA).
The Guidelines develop minimum standards when evaluating a patient who presents in the ED with psychiatric symptoms. The Guidelines:
Assist with efficiently identifying potential medical etiology and medical co-morbidities requiring treatment.
Encourage and reinforce doctor-to-doctor communication and collaboration through the establishment of procedures for amicably resolving concerns around psychiatric admissions.
Outline the admission limitations of state psychiatric hospitals and crisis stabilization units (CSUs) through a list of exclusionary criteria.
Establish the Protocol Review and Monitoring Committee (PRMC) to monitor implementation and recommend revisions to the Guidelines as needed.
