Virginia’s hospitals, emergency physicians, and the state’s behavioral health agency have created a landmark new set of protocols for assessing the medical condition of patients experiencing a psychiatric crisis to ensure those patients are admitted to the appropriate facility to meet their treatment needs.
This accord, two years in the making, formalizes a consensus built out of discussions with clinicians and other behavioral health stakeholders. The agreement establishes baseline standards for use when evaluating a patient who arrives at a hospital emergency department with psychiatric symptoms and determining the proper setting for care. In those scenarios, the Medical Assessment and Screening Guidelines will function to assist in identifying the potential cause of a patient’s distress, as well as any other chronic medical conditions from which a patient might suffer.
The guidelines emphasize and underscore the importance of doctor-to-doctor communication and collaboration by setting procedures for amicably resolving concerns about psychiatric admissions. The guidelines also create a process for performing toxicology and other screening tests on patients who present at an emergency room in need of mental health attention to rule out other factors that may complicate a diagnosis and assessment prior to psychiatric care. The goal of these guidelines is to provide consistency in evaluating patients with mental health needs and medical conditions to determine the proper place for care, whether that is in a psychiatric hospital, an inpatient psychiatric unit, or a crisis stabilization unit.
These new guidelines, which will be reviewed on an ongoing basis, were formally implemented across the Commonwealth on November 5. They arrive at a time when local Community Services Boards (CSB) have in recent years seen an uptick in psychiatric evaluations, when public psychiatric hospitals have experienced significant growth in the admission of patients under a temporary detention order (TDO) with immediate psychiatric treatment needs, and when private hospitals have encountered an increase in the number of patients voluntarily entering hospitals for inpatient psychiatric care.
The guidelines also establish a five-member Protocol Review and Monitoring Committee (PRMC) to assess adherence to the medical assessment standards and to promote proper, uniform implementation. The PRMC is empowered to review cases of disagreement between emergency department physicians and psychiatrists that were escalated under the protocols to improve the resolution process. It will meet at least twice a year.
Speaking about the collaborative guidelines, Virginia College of Emergency Physicians President Dr. Bruce Lo, MD, FACEP, said they “will help streamline the medical assessment as well as reduce costs and time needed to help take care of patients presenting with psychiatric emergencies.”
“Virginia’s state hospitals provide specialized treatment to individuals with serious mental illness and are not equipped to handle serious or active medical conditions,” added Virginia Department of Behavioral Health and Developmental Services Commissioner Dr. S. Hughes Melton, MD, MBA. “Transferring individuals to state hospitals who are under a TDO and are acutely intoxicated or in withdrawal presents a risk to their health and may have tragic consequences. The new guidelines will improve patient safety, increase communication, and potentially divert people from inpatient psychiatric care when acute medical care is more appropriate.”
“There is a growing demand for mental health treatment services in Virginia,” said Virginia Hospital & Healthcare Association President and CEO Sean T. Connaughton. “Community hospitals and state hospitals have experienced this in responding to the needs of TDO patients and voluntary patients. In the past few years, local hospitals in Virginia have seen substantial growth in the number of patients seeking mental health treatment. The development of these guidelines is a testament to the collaboration that exists among Virginia’s health care community, and they put in place an important framework to help ensure patients get the care they need in the proper clinical setting.”
Virginia Association of Community Services Boards Inc. Executive Director Jennifer Faison said her organization and CSBs around Virginia are “hopeful that this cooperative protocol for medical assessment will expedite evaluation in emergency rooms and help people get appropriate care more quickly.”
“Members of the law enforcement community, including personnel from local sheriff’s offices, increasingly are called to respond to situations involving people experiencing mental health crises,” added Virginia Sheriffs’ Association Executive Director John W. Jones. “When that happens, sheriff’s deputies who transport a person in need of a psychiatric evaluation often find themselves serving as that person’s chaperone and their source of transportation to an evaluation, and sometimes to an available psychiatric bed in a hospital that is hours away from their home jurisdiction. While our dedicated sheriff’s deputies take their duty to protect and serve the public seriously, there is a drawback to those situations – deputies involved can be pulled away from their regular safety patrol and emergency response duties for hours at a time, which has public safety implications. These standardized guidelines are an important, collaborative step forward as we continue to work to improve Virginia’s mental health system.”
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