Lack of Follow-up Can Lead to Lawsuit

If a psychiatric patient is being sent home, the EP must determine if there is proper follow-up available for that patient, which means connecting the patient with appropriate resources, says Leslie Zun, MD, MBA, professor and chair in the Department of Emergency Medicine at Mount Sinai Hospital and Chicago (IL) Medical School.

“The first problem is, do we have psychiatric resources either in the hospital or the community? And the second problem is, what do we do if we don’t?” says Zun, adding that patients might have to be sent long distances to get to an appropriate resource.

To reduce legal risks, EPs tend to err on the side of admitting psychiatric patients, says Zun, but might feel more comfortable sending patients home if there were appropriate resources available post-discharge. Ideally, EPs consult with a psychiatric provider, just as they sometimes do with a patient’s primary care physician for a patient with a chronic medical illness, he advises.

EPs also need to tell patients what to do if they get worse, when to return to the ED, and determine what type of resource a mentally ill patient needs, such as an outpatient substance abuse treatment facility or a crisis residential facility. Ideally, this is done by a psychiatric social worker in the ED, but many EDs lack this resource, says Zun. “It’s quite a burden to the EP to find all those services. But if we sent them out without those things, that puts us at risk,” he says.