Emergency Medical Evaluation of Dangerousness

eMed International Inc

Suicidal and Homicidal Assessments

AHRQ Studies Detail ED Use for Mental Health & Substance Abuse Disorders

According to a News and Numbers report from the Agency for Healthcare Research and Quality (AHRQ), nearly 12 million visits made to US hospital EDs in 2007 involved people with a mental disorder, substance abuse problem or both. This accounts for one in eight of the 95 million visits to EDs by adults that year. Of these visits, about two-thirds involved patients with a mental disorder, one quarter involved patients with a substance abuse problem, and the rest involved patients with both a mental disorder and substance abuse.  Read entire article on the American Academy of Emergency Medicine website.

STANDARD OF CARE

Psychiatric emergencies relate to safety and training to ensure optimal outcomes. The Joint Commission on the Accreditation of Hospitals Organization (JCAHO) has developed standards for reducing the risk of suicide which are applicable to EDs. These standards are relevant to clinician assessment, maintenance of safety in the environment, training of staff, and provision of transitional care when at-risk patients are maintained in the ED. In addition, the American College of Emergency Physicians (ACEP) has developed guidelines that address diagnosis and management of psychiatric patients in the ED during an initial assessment. Those patients with histories suggesting acute or exacerbated medical illness who have abnormal vital signs and abnormal physical examination findings must be cleared of medical illness during their evaluation in the ED. According to the American Psychiatric Association (APA) Practice Guidelines for the Assessment and Treatment of Patients with Suicide Behaviors, all health providers performing psychiatric evaluations in the ED should be trained in an intensive and tested assessment strategy.


Emergency Departments

Emergency department (ED) direct or referred visits for attempted suicide and violence are relatively common and most frequent among adolescents and young adults.  An efficient and effective evidence-based approach in the ED is necessary, as the difficulty in diagnosis, the current lack of predictive value of available screeners, the limited time frame to initiate treatment, the life threatening complications of a missed diagnosis, and the lack of timely consultation make suicidality an intimidating entity.  eMed International™ ACUTE™/VISTA™/ACTA™ assessments may be initiated by ED staff to determine an admirably fast, valid, and reliable warning sign severity level, introduce symptom specific treatment, advance upon initial management, and serially monitor improvement or lack thereof until such time as further consultation  is obtained. The focus here is to have timely evaluation and decision making, when and where possible, acting on the next steps that will reduce delay from hours to immediate. ACUTE™/VISTA™/ACTA™ assessments are best conducted when ED clinicians attend on-site eMed Colorado™ training and certification training.

Primary care

Primary care is delivered by physicians, nurse practitioners and physician assistants practicing family medicine, general internal medicine and general pediatrics. They provide care to prevent disease, maintain health, and refer patients to specialists. Because PCPs are often the initial contact for most patients with depression and other mental disorders, they are in a unique position to provide early detection and integrated care for persons with mental and coexisting medical illness. Despite this opportunity, evaluation is frequently nonspecific and care often suboptimal. Problems can arise during several parts of the patient visit that decrease office and clinician efficiency, making it difficult to effectively care for high volumes of patients.  For example, the scheduled or unscheduled visit by a potentially violent patient not only compromises other patient’s waiting times and office staff experience, but also adds to already stressful work and waiting room environments, and enhances the potential for errors, delays in treatment, and diminished quality of care with potentially tragic consequences. In those cases where a self-report or patient-guided questionnaire highlights near-future self or targeted violence, immediate PCP referral of patient and family to an eMed International™ proficient ED serves as the specified point of contact.  Although eMed Colorado™ training and certification are not required, PCPs are encouraged to follow standards of care such as those outlined by The Joint Commission on the Accreditation of Hospitals Organization (JCAHO), American College of Emergency Physicians (ACEP), or the American Psychiatric Association (APA) Practice Guidelines for the Assessment and Treatment of Patients with Suicide Behaviors.

Public School Districts

School district use of eMed International™ assessments represents an evidence-based framework for evaluating near-future youth violence which then enable school personnel, family, and local authorities to follow district-wide institutional safety and referral protocols.  These procedures may include emergency response plans and threat risk assessments.  The ACUTE™/VISTA™ examinations may be used alone, or in combination with, preferred and approved school based evaluation tools.  The ACUTE™/VISTA™ examinations previously distributed by Psychological Assessment Resources, Inc., Lutz, FL (www.parinc.com) to school districts and counselors throughout the U.S. and world-wide for eight years, are now exclusive eMed International™ intellectual properties. ACUTE™/VISTA™ assessments are best conducted when school nursing, counselor, and psychologist personnel attend on-site eMed International™ training and certification.  

Clinician Benefits

     eMed International™ strives to understand the challenges of clinicians responsible for evaluating youth emergent suicidality in a variety of settings.  These encounters are complex and challenging for incompletely or untrained clinicians, and poorly staffed or overcrowded primary care, emergency department (ED), and school counselor facilities.  Further adding to this immense task is little or no evidence of the value of recent emergency screening assessments, and scarceness of timely mental health follow-up consultation and treatment.

     Nevertheless, eMed International™ endeavors to meet and exceed the following objectives: (1) center on the clinician’s experience; (2) speak in their language; (3) recognize what they care about; (4) attempt to link the specific assessment to the clinician’s objectives.

     eMed International™ differentiates its value from other screening tools by applying empirically-based and peer-reviewed evidence of unambiguous value to specific service providers.  Although assessment experiences may originate from different levels, i.e., primary care, ED, and school district settings and remembering that one size does NOT fit all assessment situations, eMed International™ attempts to align people, processes, products, and services to meet and exceed clinician requirements and expectations.  eMed International™ presents an innovative framework to create an end-to-end experience that drives clinician beliefs about patient benefits at the highest level.  

     Based on best practices, eMed International™ encourages a customized assessment plan for specific clinicians.  The brief outlines on this page represent an integrated, multi-level system designed to provide a clear and consistent clinician-focused line of sight.

     To ensure optimal outcomes in the assessment of youth suicidality, ED and school district mental health providers should be trained in ACUTE™/VISTA™/ACTA™ assessments in accordance with the assessment goals outlined in the sidebar.