Toxic Ingestion Clinical Pathway — Emergency Department, ICU and Inpatient
Behavioral Health Consultation
Emergency Department
Behavioral health consultation from the emergency department is required for children or adolescents who report suicidality or homicidality.
Safety observation should be requested for children or adolescents who present with concern for intentional ingestions or intent to self-harm.
In addition, behavioral health consultation is recommended in the following circumstances:
- Any concern for self-harm reported by child or caretakers
- Concerns on Behavioral Health Screen (BHS) for depression, trauma, and/or current suicidal ideation
- Intentional ingestions where the history and/or context of the ingestion suggest poor insight or impulse control, regardless of stated intent to self-harm
- History of substance use disorder
Of note, in the ED a behavioral health consult is initiated by consulting the Social Work team who will request psychiatry involvement, as needed.
Inpatient/ICU
Behavioral health consultation is recommended for:
- All intentional ingestions that require an inpatient hospital stay, regardless of intent to self-harm
- Patients with known or suspected risk of alcohol, benzodiazepine, or opioid withdrawal
In addition, Adolescent Medicine and Social Work consultations are recommended for all adolescents with known or suspected substance use disorders upon admission.
Patients admitted to the ICU or inpatient floors with a suicide attempt or ingestion with intent to self-harm should have the Suicide Prevention Bundle ordered within the Behavioral Health Order Set.
Behavioral Health consultation should be requested once:
- The patient no longer has ICU-level medical needs
- The patient is able to participate in a detailed behavioral health interview
- Medical needs are resolving, and the primary team has begun discharge or disposition planning