Emergency Department Clinical Pathway for Evaluation/Treatment of Children with Behavioral Health Concerns
ED Patients with Behavioral Health Concerns
- All Patients:
Behavioral Risk Assessment to determine interventions to maintain safety - Patients ≥ 10 yrs:
Complete Ask Suicide-Screening Questions (ASQ)
Mood/Behavior | Risk Level | ≥ 10 years of age | < 10 years of age | Action |
---|---|---|---|---|
All suicide risk levels and aggression: Page Social Work on call Place RED EPIC Security Flag Expedite to ED Room, use BH Rooms as able |
||||
Suicide | High |
|
|
|
Moderate | ASQ: Yes to questions 1 or 2 | History of suicidal ideation or self-harm in the last month | Immediate Visual 1:1 with CHOP Staff Observer or Appropriate Adult Visitor (AAV) | |
Low | ASQ: No to all questions | No history for suicidal ideation or self-harm | Immediate Visual 1:1 with AAV or CHOP Staff Observer | |
Aggression | High |
|
Immediate Visual 1:1 with CHOP Staff Observer Notify Security and Team Attending |
|
Moderate | Calm but history of aggressive behavior | Review 1:1 need | ||
|
- Other Considerations
- Columbia Suicide Screening
- Wanding
- Psych Tech Role, Responsibilities
- Voluntary/Involuntary Hospitalization
- COVID Considerations
- Forensic Patient
- HOH Process
- RN Actions, Documentation, and Orientation to ED Room
- Indications for 1:1
- Patient, Room Safety and Caretaker Guidance
- Change to gown
- Search person & belongings
- Store belongings
- Caretaker Guidance for ED and EDECU
- Review belongings
- AAV expectations
- Documentation
- Behavioral Health Screen Eligibility, Follow-up
- De-escalation Strategies
- Medications
- Anxiolysis
- Aggression
- Restraints
- Review Checklist
- Ensure Order
- Face to Face Evaluation
- Monitoring
- Documentation
- Brief History, Physical, Development, MSE
- Initiate 1:1 as indicated and place order
- Review Differential Diagnosis
- Further Diagnostic Testing
- Medical Clearance
Disposition
Inpatient Medical Admission
EDECU, Awaiting Inpatient Psychiatric Transfer
Inpatient Psychiatric Admission
Discharge
- Requires Medical Care
- Not Eligible for EDECU
- Admission Location, Process
- Ensure 201 or 302
- Transport Form Signed by ED
- Attending
- Ensure Belongings with Patient
- Child Life and Team Prepares
- Patient for Transfer
- 1:1 Observation
- Safety Plan
- Partial Program
- Outpatient Referral
- Community Resources
- Ensure Belongings with Patient
Posted: February 2013
Revised: February 2021
Authors: J. Lavelle, MD; M. M'Farrej, MD; J. Esposito, MD; A. Jhonsa, MD; E. Perry, MSW; K. White, MSW; E. Steinmiller, RN; A. Felix, CRNP; K. Crescenzo, RN; MK. Abbadessa, RN, A. Fu, MD, C. Jacobstein, MD, K. Osterhoudt, MD; E. Friedlaender, MD
Revised: February 2021
Authors: J. Lavelle, MD; M. M'Farrej, MD; J. Esposito, MD; A. Jhonsa, MD; E. Perry, MSW; K. White, MSW; E. Steinmiller, RN; A. Felix, CRNP; K. Crescenzo, RN; MK. Abbadessa, RN, A. Fu, MD, C. Jacobstein, MD, K. Osterhoudt, MD; E. Friedlaender, MD