Just finished a CPEP (psych ER) shift. How it works at my hospital is that patients brought in to the CPEP are evaluated by a psychiatrist. If we feel there's a medical concern that can't be treated by us, we transfer to the main ER for medical treatment prior to admission or transfer back after stabilized.
We tend to have a good relationship with the ER doctors (mostly because they're overjoyed that they don't have to deal with any psych patients who present to them lol) but yesterday was a bit of an issue.
When I came on to shift, the psychiatrist coming off told me incredulously how much push-back he got for transferring a patient with 200/120 BP to the main ER. He was convinced that this required workup to rule out stroke or other major issue. I didn't argue with him (he's an attending, I'm a resident) but my understanding of the literature is that asymptomatic hypertension wouldn't be treated in an ED anyway and so it was actually a completely pointless transfer. Long story short, I quickly accepted the patient back after he left (they did no workup in the ED other than restarting home meds which is completely reasonable imo) and things are fine.
My question to you guys, however, is what things like this would you like your psych colleagues in CPEPs/PES/PEC's to know? This is the first time I've run into this but I'm sure that attending has transferred many patients to the ED with asymptomatic hypertension. What other common things do you guys see from the psych side that you wish we would know how to handle better?
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