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Medical Clearance of Psych Patients in the Emergency Department

By Tori Rodriguez, MA, LPC, PsychiatryAdvisor

(PsychiatryAdvisor) - Psychiatric complaints prompt an estimated 4.9% to 6.3% of all emergency department (ED) visits in the United States. This number is increasing for various reasons, including a shortage of psychiatrists, closure of state mental hospitals, and reduced funding for community mental health care. “As a result of these and other factors, psychiatric emergency visits are resource-intensive, longer, and may [also] contribute to crowding” due to their impact on lengths of stay and wait times for all ED patients, according to a paper published in 2017 in the Western Journal of Emergency Medicine.

In addition, various studies show that 19% to 80% of psychiatric patients have comorbid medical illness, which may cause, contribute to, or worsen psychiatric symptoms. ED physicians must often provide “medical clearance” of these patients before they can be transferred to psychiatric care, and these exams have become more intensive as the medical capabilities of the receiving psychiatric facilities has diminished. However, there is a lack of consensus between psychiatrists and ED doctors regarding standard protocols for the evaluation of psychiatric patients. This is likely one reason that medical comorbidities are often overlooked in this patient population — in 80% of cases, according to one study.

Psychiatric hospital stripped of certification, federal funding

Western State Hospital, a 147-year-old psychiatric hospital in Lakewood, Wash., will lose its Medicare certification and $53 million in annual federal funds July 9 after failing a recent inspection, according to The News Tribune. The loss of federal funds comes two years after the state's largest psychiatric hospital implemented a correction plan to improve safety and quality of care to meet federal standards.

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