Emergency Department Clinical Pathway
for Behavioral Health Concerns

Presenting with Behavioral Health (BH) Concerns
Identify Predominant Symptom: Notify Social Work, Call for Safety Observer
Expedite to ED Room, use BH Rooms as able, place RED Epic Security Bell
  • ≥ 8 yrs
    • ASQ: positive or child refuses ASQ
  • All Ages
    • Active suicidal ideation or attempt present
    • Parent/guardian report SI, or attempt in the last month
  • Active physical aggression to self, others, property
  • Active verbal aggression
Use CHOP Staff Observer for all children even if: Transferred from Inpatient Psychiatric Hospital
BH complaint and in Law Enforcement Custody, notify Security
Indications for Safety Observation when other behavioral health concerns are present
BH Code Response
RN Actions
History, Physical Examination, and BH Assessment
Agitation Assessment
Agitation Treatment
Least Restrictive Intermediate Most Restrictive
Medications Manual Holds, Restraints

Ongoing Assessment

Medication side effects
Changes in care plan, shift changes, new behaviors

Not Medically Cleared
Medically Cleared
Awaiting Inpatient Psychiatric Transfer
  • Safety Plan when indicated
  • Ensure follow-up resources
  • Community Resources
  • Belongings with child
  • PCP communication
Posted: February 2013
Last Revised: June 2024
Editors: Clinical Pathways Team