Emergency Department Clinical Pathway for Evaluation/Treatment of Children with Behavioral Health Concerns

Goals and Metrics
Red Flags
ED Patients with Behavioral Health Concerns
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
  • ASQ: Yes to questions 3, 4, or 5
  • Patient refuses ASQ
  • Active suicidal ideation or attempt
  • Parent/guardian reported suicidal ideation or attempt within past week
  • Active suicidal ideation or attempt
  • Parent/guardian reported suicidal ideation or attempt within past week
  • Immediate Visual 1:1 with CHOP Staff Observer
    • Visual & Arms-Length 1:1 as indicated
    • Page Psychiatry early if intent unclear
    • Notify Team Attending
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
  • Active physical aggression towards self, others or property
  • Active verbal aggression
 Immediate Visual 1:1 with CHOP Staff Observer
Notify Security and Team Attending
Moderate Calm but history of aggressive behavior Review 1:1 need
  • Patients Presenting with other Behavioral Health concerns may need 1:1 Observation and other Safety Practices
  • Patients coming from inpatient Psychiatric Facility, perform BH Triage screen and use CHOP Staff 1:1 regardless of screen result
  • Patients in law enforcement custody, initiate CHOP 1:1 observer, notify security
Disposition
Inpatient Medical Admission
EDECU, Awaiting Inpatient Psychiatric Transfer
Inpatient Psychiatric Admission
Discharge
  • 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: July 2015, November 2016, February 2018, April 2018, October 2018, 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