First AD

Second AD

A. Always treated on medical-surgical floors, since the underlying disease process is organically based

B. Referred to psychiatric units since it is the behavior which is the focus of care

C. Managed in the least restrictive environment possible

D. Kept away from psychiatric units because this will complicate nursing home placement 

In the emergency department, patients with behavioral disturbances and especially those with illnesses such as dementia, TBI, autism spectrum disorder, and intellectual disability should be managed in the least restrictive environment possible due to the problems posed by many health insurance plans.

Behavioral health reviewers are often unwilling to authorize care on psychiatric units when the patient is not considered “medically stable” or if it appears that the chief reason for a transfer to a psychiatric unit is related to placement rather than a need for further acute treatment.

The restrictions on medical interventions frequently come at the insistence of state or local licensing agencies In the emergency department, or even when referral is considered from an outpatient clinic, patients with symptoms suggestive of a need for psychiatric hospitalization require assessment for appropriateness of setting.

Medically and Psychiatrically Complicated Patients

Quizzes

Comorbidity

Psychiatric Emergencies

In the emergency department, how should patients with behavioral disturbances and especially those with illnesses such as dementia, TBI, autism spectrum disorder, and intellectual disability be managed? Take the quiz and learn more.

Mini Quiz: Behaviorally Compromised Patients

Kenneth Certa, MD