Impacting Mental Health Emergency Care

Thursday, 15 July 2010

Susan E. Dierker, RN, MSN
Medical Care Line, Michael E. DeBakey VAMC, Houston, TX
Nini G. Ramirez, RN, MSN
Emergency Room, Michael E. DeBakey VAMC, Houston, TX

Learning Objective 1: The learner will be able to understand the use of the 5 levels of triage for patients presenting to the ER with Mental Health conditions.

Learning Objective 2: The learner will be able to understand the Crisis Intervention Team (CIT) for rapid hand off of acutely ill mental health patients.

The Michael E. DeBakey VAMC Emergency Room (ED) had a dramatic increase in the numbers of patients seeking mental health services.  This resulted in increased length of stay in the emergency department for patients waiting Mental Health interventions.  The lack of appropriate mental health triage criteria was assisting the crisis in the emergency room.  Because of these issues patients were eloping from this area and a heavy use of the Code Green team to subdue patients was becoming a frequent occurrence.  This collaborative project between the Emergency Room and Mental Health changed the triage process for patients with mental health issues.  A 5 level triage tool was modified from an existing tool that was developed by the Victorian Emergency Department Mental Health Triage Project 2000 and piloted in the emergency room.  A Crisis Intervention Team (CIT) was developed which improved hand off of high risk mental health patients for admission.  This new process has allowed for appropriate triage and intervention of patients with mental health illnesses, decreased ER length of stay, timely admission, and decreased use of the code green team and created a safer environment for patients and staff. References:

State Government of Victoria, Australia, Department of Human Services, “Mental Health and Victoria’s Emergency Department”, September, 2006,

Australasian College of Emergency Medicine (2000). Guidelines for the implementation of the Australasian Triage Scale (ATS) in emergency departments.

Kessler, R. C., et al, (2005). Prevalence and treatment of mental disorders, 1990 to 2003. The New England Journal of Medicine, 35(24), 2515-2523.

Lambert, M. T. (1995). Psychiatric crisis intervention in the general emergency service of a Veterans Affairs hospital. Psychiatric Services, 46(3), 283.

Lambert, M. T., et al. (2003). Five-year outcomes following psychiatric consultation to a tertiary care emergency room. American Journal Psychiatry, 160(7), 1350-1354.