Psychiatric Emergencies in Nonpsychiatric Settings: Perception Precludes Preparedness

Area of Science:

• Medical emergency response
• Psychiatric care in general hospitals
• Healthcare systems management

Background:

• Hospital emergency codes typically address general crises, not distinct psychiatric emergencies.
• Current "security-first" approaches prioritize containment over treating underlying psychopathology.
• Psychiatric crises in medical/surgical settings are often misclassified as security issues.

Purpose of the Study:

• To highlight the overlooked medical intervention opportunities in psychiatric emergencies.
• To address the failure of hospital systems in developing infrastructure for clinically-informed psychiatric emergency response.
• To propose behavioral emergency response teams (BERT) as a collaborative care model.

Main Methods:

• The article presents a perspective on current practices and proposes an alternative model.
• It discusses the role of BERTs in re-establishing patient care while maintaining security.
• Utilizes the "Swiss cheese" model of human error to illustrate BERT advantages.

Main Results:

• Misconception of psychiatric emergencies as security functions leads to missed medical intervention opportunities.
• Lack of appropriate infrastructure results in adverse clinical, safety, and financial outcomes.
• BERTs provide clinical oversight, acting as surrogates for consult-liaison psychiatry.

Conclusions:

• Behavioral emergency response teams integrate patient care with security containment.
• BERTs address acute psychiatric needs efficiently, supporting primary teams without additional psychiatric resources.
• BERT implementation offers multilayered advantages in managing psychiatric emergencies in non-psychiatric settings.