Behavioral Health Issues Clinical Pathway — Emergency Department

Brief History, Physical, Development, MSE

Team-based Rapid Assessment

For optimal care, the ED team members should meet the child and do a brief initial evaluation together.
The Social Worker and Psychiatrist will obtain the majority of the psychosocial history.
Involve Child Life early on in the ED stay.
Multiple history and physical exams by individual providers may increase stress for these children contributing to escalation.
Update the child and family on plan for ED care and disposition.

Staff Roles and Responsibilities

Role	Responsibility
ED MD/APP/RN	Perform brief initial evaluation together Brief assessment of chief complaint Focused evaluation for medical condition Assure safety observation, room safety as indicated Inform family of ED care process Minimize stimulation Minimize ED LOS
Child Life	Behavioral management strategies Communication with family and ED team
Social Work	Psychosocial history Communication with family, ED team and medical home Discharge/transfer
Psychiatry	Consultation ED safety plan Disposition planning Communication with family and ED team

Focused Medical History and Physical Exam

History/Examination	Psychiatric Complaints	Developmental Issues
HPI	Brief description of reason for visit Depression symptoms Suicidal ideation Auditory hallucinations Behaviors leading to unsafe environment Symptoms concerning for organic disease Determine ways to de-escalate	Brief description of reason for visit Review agitation triggers (general + hospital specific), behaviors leading to unsafe environment Determine ways to de-escalate Determine optimal methods of mutual communication Methods of determining presence, severity of pain
PMH	Medical diagnoses Previous hospitalizations (medical, psychiatric) Outpatient therapy	Medical diagnoses Hospitalizations
Development	Current diagnoses	Current diagnoses
Medications	Prescription, OTC	Prescription, OTC
ROS	Focus neurologic, endocrine disease	Focused on chief complaint
PE	Skin exam for injury Signs of organic disease	Focused on chief complaint
MSE	Appearance Orientation: person, place, time, and situation Memory: short and long term Cognitive: intelligence, fund of knowledge, reasoning Behavior: activity level, age appropriateness Affect (observed) Mood (reported) Thinking: thought processes, thought content Verbal communication: coherence, goal-directedness, loose associations, speech

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Behavioral Health Issues Clinical Pathway — Emergency Department

Brief History, Physical, Development, MSE

Team-based Rapid Assessment

Staff Roles and Responsibilities

Focused Medical History and Physical Exam

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Innovation and your child

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Behavioral Health Issues — Brief History and Physical — Clinical Pathway: Emergency

Behavioral Health Issues Clinical Pathway — Emergency Department

Brief History, Physical, Development, MSE

Team-based Rapid Assessment

Staff Roles and Responsibilities

Focused Medical History and Physical Exam