Somatic Symptom and Related Disorders (SSRD) — Discharge Planning — Clinical Pathway: Emergency Department and Inpatient

Somatic Symptom and Related Disorders (SSRD) Clinical Pathway — Emergency Department and Inpatient

Discharge Planning

When discharging a child with SSRD from the ED or inpatient floor, it is important to emphasize to the child and caregiver that symptoms may improve with use of new coping tools and mindfulness techniques in the SSRD care bundle, but symptoms may also wax and wane and that recovery and remission from SSRDs may take weeks to months of sustained therapy and work. Function tends to improve before symptoms, as the mind and body make new healthy connections.

Medical
  • Contact PCP within 1-2 Weeks of Discharge
    • Review admission and recommended treatment plan
    • Important points of this handoff discussion may include an explanation of the workup completed in the ED or inpatient floor, SSRD diagnoses communicated to the child/family, strategies and coping tools given to children, and treatment plan initiated. While new symptoms should not be ignored, they should be evaluated first in the primary care office, and efforts should be made to communicate the treatment plan with the PCP to facilitate transition to outpatient care.
  • Consider PT/OT Referral
    • PT/OT can reduce SSRD symptoms. Consider PT/OT when mobility, strength, function, or activities of daily living (ADLs/IADLs) are impaired by symptoms, including somatic pain that would benefit from desensitization therapies. Isolated somatic symptoms that do not cause significant disruption to function and ADLs do not necessarily require PT /OT referrals.
  • Provide SSRD PFEs and Care Bundle
  • Other Referral Considerations (e.g., AMPS, GI, AADP)
    • Not all somatic symptoms require referral to subspecialty care.
    • Referral to Comfort Ability should be considered for any SSRD child with a significant pain component.
    • Most SSRDs can be managed by PCP with good inter-provider communication. However subspecialty referrals may be indicated for debilitating SSRD symptoms. Please avoid placing multiple referrals to avoid dual-evaluation and siloing of care.
      • Widespread pain (AMPS)
      • Interdisciplinary Care for Abdominal Pain and Symptoms (ICAPS Program in GI)
      • Dysautonomia symptoms (AADP)
      • Functional Neurologic Disorder symptoms (Rehab)
      • Gait Disturbance (Rehab)
  • Review Medication Management
    • Symptom focused medications do not tend to improve somatic symptoms.
    • Consider if a short course of supportive medications may be appropriate.
Behavioral
  • Warm handoff with outpatient mental health provider as able
    • Families and therapists often seek a provider who is familiar/expert in SSRDs, who are exceedingly rare in the community setting. It is more realistic to empower outpatient mental health providers to use evidence-based treatments such as CBT that they know well to treat SSRDs. CHOP Providers may be able to support community providers on a consultative basis.
  • Work with BH disposition team to begin process of establishing mental health care.