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 ≥ 8 yrs
Complete Ask Suicide-screening Questions (ASQ)
Mood/Behavior | Risk Level | ≥ 8 Years of Age | < 8 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 |
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Suicide | Acute |
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Non-acute |
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Immediate Safety Observation with CHOP Staff Observer until formal risk assessment completed | |
Negative Screen | ASQ: "No" to all questions | No history for suicidal ideation or self-harm | Review considerations below for potential Safety Observation need | |
Aggression | Acute |
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Non-acute | Calm but history of aggressive behavior | Review considerations below for potential Safety Observation need | ||
|
- Other Considerations
- Columbia Suicide Screening
- Wanding
- Psych Tech Role, Responsibilities
- Voluntary/Involuntary Hospitalization
- COVID-19 Considerations
- Forensic Patient
- HOH Process
- RN Actions, Documentation, and Orientation to ED Room
- Indications for Safety Observation
- 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 Safety Observation 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
- Safety Observation
- Safety Plan
- Partial Program
- Outpatient Referral
- Community Resources
- Ensure Belongings with Patient
Posted: February 2013
Revised: October 2022
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, ACCNS-P; A. Fu, MD; C. Jacobstein, MD; K. Osterhoudt, MD; E. Friedlaender, MD
Revised: October 2022
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, ACCNS-P; A. Fu, MD; C. Jacobstein, MD; K. Osterhoudt, MD; E. Friedlaender, MD