Pediatric emergency medicine trisk 4152 4152
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It is vitally important to ensure patients do not bring weapons or other
dangerous objects into the ED. Procedures to achieve this end may include
use of metal detectors or a physical search of the patient and their
belongings. Some EDs use a protocol whereby all patients must wear a
hospital gown and slippers while in the ED. This separates the patient from
their belongings and can facilitate a search for harmful objects. Such a
policy may also theoretically reduce the risk of patient elopement.
A safe and adequate physical space is an absolute requirement of the ED.
Patients with high risk of harm to self/others need to be under constant
supervision by either ED medical or security staff via direct visualization of
the patient or by continuous video monitoring. At a minimum, the patient
room should be free of objects that could cause harm including objects used
for strangulation (e.g., medical tubing, electrical or equipment cords). Such
objects should be either inaccessible to the patient (e.g., in locked cabinets)
or physically removed from the room.
The optimal setting for a psychiatric evaluation is a quiet and lowstimulus environment in which interruptions are infrequent, and privacy and
confidentiality are assured; ideally this environment would be a separate,
distinct area from the main ED with direct access to medical and security
staff and capacity for using restraints.
Clinicians in the ED should have a pre-existing relationship with a mental
health team that is committed to providing child psychiatric consultation at
all times. The ED should also have relationships with (a) psychiatric
inpatient unit(s), for efficient transfers and hospitalizations when needed.
The staff should be thoroughly familiar with the procedures for psychiatric
hospitalization, including the specific legal requirements for involuntary
commitment. The hospital should have specific guidelines or protocols for
the management of psychiatric patients requiring admission for treatment of
medical conditions.
Finally, the ED should have relationships with other social agencies and
an awareness of relevant laws. The police should be aware of which children
to bring to the ED for psychiatric assessment and should be prepared to
remain in the ED until adequate security has been arranged. Relationships
should be developed with community mental health resources, temporary
shelters, and other crisis intervention centers, ensuring effective referrals
