Psychiatric Triage and Screening

Trends, Parameters, and Limitations When Evaluating Patients in an Emergency Room Setting

by Malik Abdur-Razzaq

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Synopsis

Numerous societal factors have given rise to acute psychiatric conditions in patients referred for mental health evaluation and treatment at a specified emergency room (ER). Some of these risk factors include homelessness, domestic violence, unemployment, and poverty; acute and recurring mental illnesses; comorbid disorders, and the effects of war as evidenced by soldiers returning home from overseas with signs of post traumatic stress disorder (PTSD) symptoms. The increase in referrals from correctional facilities, jails, juvenile detention centers, group homes, nursing homes, and schools points to institutions overwhelmed and having difficulty managing their specific populations. As a result, these groups and individuals are referred for psychiatric emergency services.

Nurses at the selected ER are primarily trained to respond to patients with physical medical emergencies and occasionally do not understand psychiatric clinical descriptors that impact on mental health patients. There is a need to educate ER nurses regarding psychiatric conditions and how best to respond to a patient’s illness predicament. In addition, no crisis specialist is assigned to triage duties in the ER to assist nurses in forming a comprehensive assessment that can determine if the referral to psychiatric screening is appropriate. Therefore, a mental illness triage protocol for non-psychiatric nursing staff in the emergency room will be proposed and, accordingly, compared to the existing protocol as a means for increasing the number of appropriate mental health referrals.

The purpose of the study is to increase the knowledge of nurses assigned to mental health patients, improve the number of patients referred, and to accurately assess the appropriateness of patients seen on the crisis unit. Consequently, this researcher proposes to provide a series of psychiatric screening classes and will offer them to ER and triage nurses who directly and indirectly have contact with the mental health population at the designated ER.