Our Partners: Emergency Rooms
Whether connected with a medical hospital or a lone free-standing ER, our team understands the importance of assessing psychiatric patients in a timely manner and creating safe dispositions. We also understand the challenges with decompensated psychiatric patients who are boarding. There are deficits in psychiatric bed counts. Psychiatric hospitals have limited capacity to manage comorbid complex medical problems. This leaves many patients in limbo and struggling with active symptoms in the ER. Furthermore, the nature of an ER environment leads to adverse outcomes, including repeated chemical and physical restraints for patients and assaults on medical staff.
We provide specialty access and timely treatment for patients in the ER.
From day one, our team understands system challenges and will work to recommend the appropriate disposition and decrease symptom burden. We operationalize a concept called treatment planning with the goal of stabilizing patients as quickly as possible, assuming that there may not be a psychiatric bed available in a timely manner. In addition, more stabilized patients can potentially be moved quickly to inpatient psychiatry or safety planned to the community, thus improving hospital throughput. Our team creates and manages a rounding list to actively follow patients throughout their stay in the ER. The aim is to proactively treat from point of contact, support the medical team, provide continuity with the same face day to day, reduce risk, and decrease length of stay.
What We Do
Our team delivers exceptional expertise by drawing on a network of highly specialized professionals across various medical and behavioral health fields. This allows us to offer integrative, evidence-based, and patient-centered care that is carefully tailored to address the unique and complex needs of each individual. From in-depth diagnostic impressions to nuanced recommendations, we are committed to providing actionable insights that empower patients and medical teams alike.
Consultation-Liaison Psychiatry
Subspecialty of psychiatry that focuses on the care of patients with comorbid psychiatric and general medical conditions. Consultation-liaison psychiatry deals with the understanding and advancement of medical science, education, and the provision of healthcare for medically ill patients. Developing a structured and systematic approach to these cases will help your hospital streamline the diagnostic workup and management of both adult and pediatric patients who develop neuropsychiatric symptoms from medical, surgical, and gynecologic illnesses, as well as patients with primary psychiatric illness whose conditions are complicated by medical illness.
Emergency Psychiatry
Subspecialty of psychiatry that deals with the rapid assessment and management of acute mental health conditions that pose a risk of harm to the individual or others, requiring immediate intervention. Developing a structured and systematic approach to these cases will help your hospital streamline crisis intervention with pharmacological and nonpharmacological solutions, leading to reduced polypharmacy & restraint use, and increased discharges and stabilized transfers to inpatient psychiatry units.
Critical Care Psychiatry (ICU)
Altered mental states (AMS) are a common presentation in the intensive care units, but diagnosing a patient with AMS can be challenging. Some presentations are clear (ex. postictal after a seizure or a diabetic who is hypoglycemic), but sometimes the clinical picture is not easily identified. The etiology of AMS can range from easily reversible conditions such as hypoglycemia, hypoxemia, and/or delirium, to more permanent ones like intracranial hemorrhage. Our expertise can help teams manage a wide variety of disease processes, such as medication toxicity, non-convulsive status, meningitis, encephalitis, and neuroleptic malignant syndrome. Developing a structured and systematic approach to these cases will help your hospital streamline the diagnostic workup and management of these patients with AMS.
Addiction Psychiatry
The prevalence of substance use disorder in hospitalized patients and those who come to the Emergency Room in crisis is quite high. Our team is equipped to diagnose and manage withdrawal syndromes (e.g., alcohol, benzodiazepines, opioids), behavioral symptoms of intoxication, and complications like delirium, while navigating polypharmacy and complex medical issues. In addition, we can assess the level of motivations a patient has for harm reduction or sobriety. And if appropriate, start medication assisted treatment through agents such as buprenorphine, methadone, naltrexone, gabapentin, and acamprosate to name a few.
Transplant Psychiatry
Most organ transplant programs recognize the need for a multidisciplinary team to assist through the continuum of care. The journey starts with a pre-transplant evaluation to help candidates be as successful as possible, factoring in goals such as sobriety, ensuring medication compliance, that primary psychiatric conditions are optimally treated, and that adequate social support is in place for organ health surveillance. Our team has specialized knowledge in recognizing and appropriately treating the psychiatric signs and symptoms that maybe linked to immunosuppressive agents such as tacrolimus or steroids. In addition, we can help manage relapse on substances post transplant and psychotropic medications for patients who are struggling with mental health issues.
Reproductive Psychiatry
Subspecialty of psychiatry focusing on the mental health needs and treatment of individuals experiencing psychiatric symptoms related to reproductive cycle transitions, including pregnancy, postpartum (depression, mania, psychosis), and menopause, as well as infertility and reproductive loss. We are experts at choosing and appropriately dosing medications in this patient population weighing the benefits for maternal health over potential risk for a fetus. We collaborate closely with OB/GYN, maternal-fetal medicine, and NICU teams to deliver integrated care for medically complex perinatal patients.
Personality Disorders/The Difficult Patient
Borderline and obsessive-compulsive personality disorders were uniquely associated with increased mean total health costs. Treatment-seeking patients with personality disorders pose a high economic burden on society, a burden substantially higher than that found in depression or generalized anxiety disorder. These high societal costs present a strong argument in favor of prioritizing effective personality disorder treatments. Personality disorders, particularly borderline personality disorder (BPD), can place a significant burden on hospitals due to increased healthcare utilization, higher rates of readmission, and the potential for challenging patient behaviors, leading to increased costs and strain on resources. Our highly trained consultation-liaison psychiatrists and psych NPs provide serial evaluations, create personalized behavioral plans, provide psychotherapeutic, and psychopharmacologic strategies that can be employed in managing these patients.
Geriatric Psychiatry
Subspecialty of Psychiatry that focuses on the biological and psychological aspects of normal aging, the psychiatric effect of acute and chronic physical illness, and the biological and psychosocial aspects of the pathology of primary psychiatric disturbances of older age. Developing a structured and systematic approach to these cases will help your hospital streamline evaluation, diagnosis, and treatment of mental and emotional disorders in the elderly.
Child/Adolescent Psychiatry
Pediatric patients that require emergency psychiatric care or medical treatment represent a vulnerable population with unique needs. Our team has the expertise to help identify whether symptoms are related to neuropsychiatric issues such as PANS/PANDAS or a primary psychiatric disorder. In addition, we tailor our approach to the developmental level of our smallest patients, helping them cope with hospital experiences that can be quit traumatic. We factor in family dynamics and support guardians through what can be a very trying time. We are truly specialists that build an umbrella bringing the care team, family, and patient together.
Psycho-Oncology
Subspecialty of psychiatry that addresses the emotional, psychological, and social challenges that individuals face during their cancer journey, from diagnosis to treatment and survivorship. Our Team understands the nuanced interaction between cancer treatments (like chemotherapy, steroids, immunotherapy) and psychiatric symptoms. We can distinguish between medication-induced delirium, depression from illness, or a primary mood disorder leading to more accurate diagnosis and care. We also provide psycho-social support as patients find ways to cope and even face existential questions.
Neuro-Psychiatry
Subspecialty of psychiatry that focuses on assessing and treating mental disorders that have a neurological basis or impact on brain function, emotion, and mood. Improving care for patients with Traumatic Brain Injury, Dementia, Delirium, Epilepsy, Multiple Sclerosis, Stroke, Movement disorders, etc. Our team is uniquely qualified to disentangle these complex presentations to provide accurate diagnosis and treatment.
Medical Decision-Making and Dispositional Capacity Assessments
Psychiatrists and Psych NPs are often consulted to determine whether a patient has the capacity to make medical decisions during a hospitalization. Some of the most challenging decisional capacity consultations are requests to determine if a patient has the capacity to participate in discharge planning (dispositional capacity). For a patient to demonstrate capacity to participate in discharge planning, the patient should have the capacity for self-care, the ability to cope with illness, and be capable of accessing medical care and treatment once they have left the hospital. Frequently, these psychiatric consultations are requested when a patient is refusing what the medical team defines as a safe discharge. Our clinicians are highly trained to navigate both medical and dispositional capacity evaluations and thus identify patients with a higher risk for complications or re-admission, leading to better discharge planning, outcomes, and a stronger medico-legal shield.
Placement challenges in the ER
ER boarding carries a high cost burden, affecting hospital systems and patients in a variety of ways. Financially, the average monetary cost to an ED to board a psychiatric patient has been estimated at $2,264 (Nicks & Manthey, 2012). Beyond the direct costs, the system becomes less efficient; ED’s are very good at addressing life-threatening emergencies but fall short when treating patients in crisis. ED boarding contributes to reduced ED capacity, decreased availability of medical/nursing staff, longer wait times for all patients, increased patient frustration, and increased pressure on the medical team. ED boarding results in increased rates of patients who leave without being seen, longer inpatient stays for those admitted, as well as lost hospital revenue and depletion of ED resources. Moreover, Providers experience a higher degree of stress related to boarding of patients, resulting in a greater risk of adverse events, and lower levels of reported patient satisfaction. ED/CL trained Psychiatrists and Psych NP’s play a powerful role in decreasing ED boarding. More importantly, the quality of services is highly dependent on the workforce engaged in these spaces. Our subspecialty-trained psychiatrists and psychiatric NP’s round on ER boarding patients, through serial evaluations, relationship building, treatment, and discharge planning, we decrease the time to acute stabilization.