Hello everyone, the above is a topic that has recently grabbed my interest that has recently grabbed my attention due to recent patient encounters and I thought it would be beneficial to introduce some discussion on it to hear opinions from medical professionals of varying backgrounds and localities.
First I'll expand on the title as I can imagine it can seem a little vague. Throughout my short five year career working in emergency medicine, both in EMS and in the Emergency Department, I've noticed one patient demographic that seems particularly prone to complications. Patients who are either introduced to the system with a chief complaint of suicidal ideation or admit to suicidal ideation during triage seem to be prone to escalating emotional distress and potential violence against healthcare workers, which can significantly derail the course of their treatment and potentially create a significant negative impact on the future of the patient and the staff.
Here's an example: 1. A patient checks in to the ER with a chief complaint of abdominal pain. 2. During triage the patient admits to suicidal ideation, oftentimes after prompting from a line of questioning that is a part of triage protocol. In my experience this patient would need to be medically cleared and would either be screened by a social worker in the room or transferred to a crisis block within the emergency department. 3. Over the course of the process of being evaluated and cleared by the social worker the patient becomes emotionally distressed from being trapped in an isolated and unfamiliar environment and begins to lash out emotionally and verbally. 4. If deescalation techniques on the part of the staff are unsuccessful it could lead to aggression from the patient and subsequent chemical or physical restraint. 4. Long term, the patient could face charges for assaulting healthcare workers and receive a treatment course entirely different from what they originally needed
Unfortunately this is a progression that I've personally seen occur several times from patients who were initially upset but cooperative and eventually descend into severe emotional distress and outright aggression. There are a few potential exacerbating factors that I can guess at: 1. Locked psyche wards in Emergency Departments that, while necessary, reinforce the feeling of entrapment in patients 2. Comorbidities such as anxiety and schizophrenia that make stressful situations much more unstable 3. The similarly necessary confiscation of personal belongings that introduces a sense of urgency and dehumanization 4. The psychological stress of not being able to track time if clocks are not present in patient rooms
This is an issue that I've experienced, however my experience is limited to a few hospitals and health systems in the Midwest and Southern United States. I'm curious what opinions you might all have on: 1. How patients who admit to suicidal ideation should be handled if it isn't the chief complaint 2. Whether these patients should be allowed to leave AMA 3. What can be done to make these situations less stressful for these patients 4. What factors may lead these patients to become distressed or violent 5. Any other thoughts you have on the issue: (If this issue is important in emergency medicine, If my understanding of the process is totally off base, If I'm talking out of my ass)
I look forward to reading all of your input!
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