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Guest kate35

Psychiatric care in A&E Depts

7 posts in this topic

Would like to get some feedback about what people feel about how psychiatric patients are cared for in A&E Depts, we are lucky in ours in that we have link nurses and on call Psychiatrists, however it being a clinical area probably not best suited to all types of psychiatric illness, would be interested to hear your opinions :)

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I think we could divide psychiatric patients in to two main groups:

1. Psychiatric patients who attend A&E for physical illnesses

2Psychiatric patiens who attend for mental illness.

My impression is that the first group are somtimes declined the proper care. However ithink some researche is needed to support this impression

Regarding the second group I am also under the impression that A&E staff are reluctant to get involved into their care (This include A&E doctors). The presense of liasion nurses has a very good impact on the standard ofcare of psychiatric patients at A&E.

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well, to answer ur question kate--it is very diffcult to assess a psychiatric patient in the a&e.usually they attend there after some overdoses/crisis--and then have to b seen by s.h.o's --who r supposed to do a quick fix .meaning that if patient is suicidal even after assessment--admit and if not--discharge for possible followup by the mental health team.

plus the patient has to tell us the history when there are other patients around.in cubiclea and separated by a curtain.

even when patients come for physical complaints ,since they have the label of mental health probs--they stil will get referred to sho's

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Thanks for your input; i do feel that sometimes, psychiatric patients are regarded as a 'special' category and not always in the best way; this is not intended as a reflection on colleagues but i think their care in an emergency dept definitely requires more proactive research 8)

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i think an other issue is how psychiatrists are treated at A&E Depts ( when they are assessing patients ,of course.) >:(

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Having worked on both sides of the fence I know how messy it can be. In A&E the typical histrionic drunk overdose patient at 3am is the last hting you need when you are alone trying to deal with sick patients in A&E which often leads to them getting a poor level of care. On the otherside psychiatrists have to struggle with A&E staff doing inadequate assessments often based on tick box forms leading to inappropriate referrals (would they dare refer to surgical SHOs without examining the patient and yet have no concerns on doign so to psych without a mental state examination).

My impression is the key lacking element is poor communnication between the two departments who are often in different trusts and inadequate training of staff int the others specialty (in both directions). This all leads to the bottmom line of patients generally getting less than ideal care.

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I hope i can help here with my own experience....

I undertook an expansive audit program of my own a&e dept in 2003..2 months was covered and essentially we looked at how may people who came into a&e got what the royal college defines as a psychosocial assessment,which it concludes in college report CR32 should be absolutely 100% of those seen with this problem.Without going into precise figures we found that may patients absconded prior to psyche assessment,several were coded wrong(eg.taken too many brufen for toothache=DSH,overdose)and still more were missed after a perfunctory(but usally adequate and more often-than-not excellent a&e assessment)excluded them from psyche follow-up with the full work-up.My own personal experience at the hospital was broadly similar to these statistics which do not give the full picture of appropriateness of referral onwards to psyche----i would often see drunk patients despite my a&e colleagues having assured me of their sobriety and competence to give a history.Nontheless,and i know it'll piss a lot of you guys off,but we are there to do a job and if standards in on-calls aren't met we can even remonitor and get paid a heck of a lot more....these a&e guys are doing the jobs we've done and would never do again or else wouldn't consider in the first place...

I think my conclusions about this particular matter can be summed up thus:

1.a&e SHOs,whilst far from perfect,are meat and grist to the mill.Like entry level psychiatrists this is often their first job,far from home,and when it isn't,you really have to keep to the fore what a difficult job it is they are doing in the first place,screening everything for everyone.

2.When it feels like you're being victimised you're not.An a&e SHO may not know an arse from a dementia but can you guys honestly say that you can differentiate between MI and pulmonary oedema compared to pneumonia.The likelihood is the poor surgical SHO has been up half the night looking at spots that were diagnosed in a&e as abscesses.

3.My results do show that the majority of patients who are willing to stay get referred to psychiatry or get a decent a&e assessment prior to leaving a&e after DSH.Despite their referral of inappropriate cases,the essential work is being done to a good standard.

4.Who wants the classic referral by a&e of the DSH case,unwilling to stay,being restrained by security anyway???Good PMP case-bad actual real life case,methinks.

5.When all is said and done,keep a checklist of pointers by your bedside and TRAIN YOUR A&E SHOs!!!Take their name,take the referral details and ask when they will be medically fit for discharge,any risk assessment they have done,and drugs and alcohol history.In particular,ask about the last time they had a drink,so that when you get there you are able to take them to task and show them what a rampant drunk looks like.DO NOT ASSUME everyone comes from a background where alcohol is consumed as freely and wildly as England!Educate your SHOs in a&e and may your 6 months be smoooooooth...

Hope that v.long rant helps a bit.

Probably not

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