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

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

Inpatient Management

Medical
  • Document diagnosis of SSRD in Medical Record
    • May also include the specific presentation, e.g. AMPS, PNEE, Functional Abdominal Pain
  • Limit non-indicated medical work up and subspecialist consultation to allow focus on the gold standard psychological and physical/occupational therapies
    • If medical subspecialty teams are consulted to help with diagnosis or communication, ensure adequate communication and background to consultant and explain medical team’s primary concern of SSRD and minimizing non-indicated work-up
  • Initial consultations with indicated subspecialists and PT/OT/SLP to address functional limitations, if applicable, within 24 hours
    • Consider reaching out to PCP, outpatient mental health care provider early to clarify historical pattern of somatization
    • Early discussion of need for Subspecialty Consultation
      • Initiate, complete medical workup to facilitate acceptance of SSRD diagnoses
      • Decrease delay in medical testing to promote discharge
    • Early discussion of need for PT/OT/SLP Consultation
      • Symptoms interfere with function or Activities of Daily Living (ADLs)
      • Can clarify whether child is physically safe to return home
      • Identifies need for outpatient PT/OT/SLP services
      • Recommendations for program after discharge
      • Recommendations for specific therapies and/or higher level of care:
        • Day hospital, inpatient rehab, specialized SSRD programs
Behavioral
  • Behavioral Health Inpatient Consult team (BHIP)
    • For SSRD psychoeducation and brief intervention
    • If requiring assistance with uncertain SSRD diagnosis and management of comorbid behavioral diagnoses
    • Recommendations for behavioral program after discharge
  • Behavioral Health Disposition Team
    • Identifies local mental health clinicians compatible with child’s insurance plan
  • Social Work
    • Recommendations for school/community support
    • Detailed social history to explore role of stressors at home impacting presentation
  • Integrative Health
    • Teach, support use of coping skills including mindfulness-based activities
Communication
  • Reinforce Goals of Admission with child and caregiver
    • Partnership with multi-disciplinary team to deliver unified diagnosis
  • Education and clarification of SSRD diagnosis
    • Focus on positive diagnostic criteria and rule-in signs, communicate them to the child and caregiver
    • Avoid focus on negative medical workup
    • Introduce and build upon relatable metaphors to explain somatization
      • Development of symptom management skills
      • Education and clarification that treatment focuses on eventual return to function
        • Integration with family and community
        • School attendance
        • Recreational activities
        • Full mobility without assistive devices
        • Managing ADLs and IADLs independently
        • Communicate clearly to family that function often improves before symptoms, and that this is normal
      • Care decisions will be driven by the inpatient team
        • Consider early caregiver meetings
        • Close attention for need for multidisciplinary team meetings
  • Provide SSRD PFEs and Care Bundle