Psychiatric Emergencies in Nonpsychiatric Settings: Perception Precludes Preparedness

A Call for Behavioral Emergency Response Teams in Inpatient Hospital Settings

“…The standardized emergency code suggestions of 21 state hospital associations fail to endorse a protocol for general behavioral emergencies that is distinct from security-only protocols. 2 Instead, behavioral emergences in the United States are frequently equated with safety threats (see Figure). RRTs are called for medical emergencies, yet US clinicians are commonly trained to call a security code when confronted with behavioral crises.…”

“…Clinical psychiatric emergencies are fundamentally medical or pharmacological (ie, agitated delirium), developmental (ie, severe autism spectrum disorder), or neurobiological (ie, decompensated psychosis) in nature or are substance induced. 2,3 Patients' coping/stress reactions describe their experiences of behavioral dysregulation after they receive bad news, such as a prognosis or diagnosis, or when they are feeling overwhelmed by the hospital course itself. Conflicts due to iatrogenic insults occur when patients experience emotional and behavioral distress after receiving poor clinical care due to clinician bias and stigma.…”

Procedural, Treatment, and Ethics Considerations of Behavioral Emergencies During Coronavirus Disease 2019 and Relaxed Seclusion Guidelines

“…Relaxed CMS guidelines are also linked to the ethics and risk management of behavioral emergencies. 4 , 5 As published by this journal last year, many American hospitals utilize a security-only protocol to respond to acute patient behavioral distress. 5 Providers must safeguard beneficence by prioritizing robust medical treatment of neurobiological and behavioral manifestations of COVID-19 2 and other medical and/or psychiatric illnesses.…”

“…4 , 5 As published by this journal last year, many American hospitals utilize a security-only protocol to respond to acute patient behavioral distress. 5 Providers must safeguard beneficence by prioritizing robust medical treatment of neurobiological and behavioral manifestations of COVID-19 2 and other medical and/or psychiatric illnesses. Further, documentation enhances continuity of care and safety during treatment planning and when transitioning providers.…”

“…Additionally, a treatment milieu that favors seclusion (even if indirectly) over clinical and patient-centered investigation during behavioral emergencies risks violating nonmaleficence by introducing needless delays and errors in healthcare delivery that hazard devastating consequences to patients’ morbidity/mortality and providers’ well-being. 4 , 5 It also endangers patients should staff fail to evaluate, document, and monitor acute medical or psychological complications of seclusion. Staff must also not be incentivized to utilize or erroneously view seclusion as a less serious impingement on patients’ autonomy, liberty, and dignity.…”