Stories about: emergency care

Delivering psychiatric care in the ED: Keeping adolescents in crisis out of limbo

Suicidal teens who come to the emergency room for help are often kept there until an inpatient bed becomes available, which can take hours or days. Elizabeth Wharff is changing the standard of care by providing family-based psychiatric treatment right in the ED.

When teenagers come to an emergency department expressing suicidal thoughts or after a suicide attempt, the accepted model of care is to evaluate, then either send them home or keep them in the ED until an inpatient psychiatric bed becomes available.

The wait for an inpatient bed can take hours, even days. No psychiatric treatment is given. The child is simply “boarded” – kept waiting in the ED under supervision, a practice that can increase distress for the child and family, while taking ED beds out of circulation for other acutely ill patients.

“Generally speaking, there is no history of providing psychiatric treatment in the emergency room setting,” says Elizabeth Wharff, director of the Emergency Psychiatry Service at Children’s Hospital Boston. “Since the late 1990s, we have seen a significant increase in the number of cases where an adolescent comes to our emergency room with suicidality and needs inpatient care, but there are no available psychiatric beds anywhere in the area.”

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The power of numbers: Rules for reining in the use of CT scans

When does a trauma patient need a CT scan? Clinical rules could help doctors decide, and in the process help reduce a child's lifetime radiation exposure. (Image: Andrew Ciscel/Flickr)

The use of computed tomography (CT) scans has dramatically changed the practice of medicine in the past two decades. Patients with abdominal pain are no longer routinely admitted for serial abdominal exams to evaluate for appendicitis, because now we can just get the CT. Children with head trauma may need less hospital observation time in the emergency department (ED), because we can just get the CT.

But “just getting the CT” comes with costs, not just medical healthcare dollars spent but the costs associated with lethal malignancies in the future caused by the radiation used in the course of CTs.

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