Emergency Department Clinical Pathway
for Behavioral Health Concerns
Presenting with Behavioral Health (BH) Concerns
EMCP Guidance
Triage
- Complete Behavioral Risk Assessment for all children and teens
- Complete Ask Suicide-Screening Questions (ASQ) for child ≥ 8 yrs
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Suicide |
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Agitation |
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BH Code Response
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Medications
- Medication by Diagnosis, Agitation
- Medications, Medications for Violent Children
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Manual Holds, Restraints
- Staff Roles
- Code Process
- Orders, Documentation
RN Actions
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Search, Room Safety and Caretaker Guidance
- Orientation to ED room, change to gown
- Search person and belongings, secure belongings away
- Behavioral Health Screen (BHS) for ≥ 12 yrs
History, Physical Examination, and BH Assessment
- ED Medical Team
- Social Work Assessment
- Columbia Suicide Screening as indicated
- Psychiatry as indicated
- Team 7/8 Behavioral Health Coverage
- ED Psychiatry Coverage
Agitation Assessment
- Team Huddle: Bedside Team, 1:1, SW
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PRESS Quick Assessment
- Past History
- Reason for Agitation
- Environment
- Social
- Severity Assessment and Response
Least Restrictive | Intermediate | Most Restrictive |
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Medications | Manual Holds, Restraints |
Ongoing Assessment
Medication side effects
Changes in care plan, shift changes, new behaviors
Disposition
Not Medically Cleared
Medically Cleared
Awaiting Inpatient Psychiatric Transfer
Awaiting Inpatient Psychiatric Transfer
Discharge
- Admit EDECU vs. Inpatient
- Admission Location, Process
- Inpatient Behavioral Health Discharge Disposition
- Safety Plan when indicated
- Ensure follow-up resources
- Community Resources
- Belongings with child
- PCP communication
Evidence
- Practice Parameter for Prevention and Management of Aggressive Behavior in Child and Adolescent Psychiatric Institutions, with Special Reference to Seclusion and Restraint
- Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry
- The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies
Media