ED Behavioral Escalation Huddle

What is a High Risk Behavioral Health Huddle?

• A High Risk Behavioral Health Huddle is an impromptu, acute meeting between key stakeholders in the Emergency
  Department (ED) and the hospital. These meetings typically occur after a patient escalation event to help establish the
  appropriate disposition of the patient, usually aiming for inpatient or medical admission. This is often necessary because psychiatric facility partners may not accept the patient onto their service.
  • e.g., the nonverbal, autistic, violent adolescent; these patients frequently cannot participate in meaningful inpatient psychiatric services yet are deemed too risky to be discharged home with family/guardian safely.

Purpose of this huddle:

• The primary purpose of the SH is to discuss the care of Behavioral Health (BH) patient(s) with extreme needs that the ED cannot provide and thus require admission to the hospital or transfer to another facility.
• The Huddle is not just a discussion; it's a time-sensitive, urgent conversation that typically occurs shortly following an
  escalation event within one hour of the huddle call-out.
  • This urgency underscores the critical need for immediate involvement and action from all stakeholders.
  • Customarily, the patient has to have a "medical need" for CMH admission, but sometimes this is not possible, and admission is still advised/agreed upon
• Also, Acute Mental Health Services (AMHS) still has to go through the official process of calling our Psychiatric facility
  partners and being "denied" transfer before an inpatient admission order is placed.
  • Inpatient admission is not ideal but is sometimes necessary due to the patient's needs and the ED's acuity.
    • There may be prolonged delays while inpatient due to staffing or re-evaluations from Psych, Social Work (SW), psychology, Child Life, medication administration/changes, etc.
• To establish with/by Psychiatry clear assessment, the need for medication changes, other specific acute interventions, and other considerations for management while in the ED

Participants in the SH:

• Medical Provider for the patient (typically Attending, but could be Fellow/Resident)
• BCBC/Psychology, AMHS, Administrator On-Call (AOC), House Shift Supervisor, Charge Nurse, Director of Nursing,
  Psychiatry
• Typically during business hours, but if extreme circumstances could be at odd hours
• If admission is being considered, include admitting team provider

Who calls t he High Risk Behavioral Health Huddle:

• Typically, AMHSor Charge Nurse, but it could be any player
• "Teams Meeting" to have everyone involved