Welcome to the Emergency Medicine Cases podcast.

I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

Psychiatric chief complaints comprise about 6 or 7% of all ED visits.

With the numbers of psych patients we see increasing every year. The ED serves as both the lifeline and the gateway to psychiatric care for millions

of patients suffering from acute behavioral or psychiatric emergencies. As ED docs, besides assessing the risk of suicide and homicide, one of the most

important jobs we have is to determine whether the patient's psychiatric or behavioral emergency

is the result of an organic disease process, as opposed to a psychological one. Now, there is

no standard process for this. On the one hand, these psych patients

are high-risk medical patients. Psychiatric patients not only have a higher incidence of chronic

medical conditions, but they're at greater risk of injury, including serious head injury,

more than the general population.

The rate of missed medical diagnoses in the ED ranges from 8 to 48% depending on which study you read,

with the highest misdiagnosis rate among first presentations.

We need to be able to identify these acute medical emergencies,

and the admitting psychiatric team certainly shouldn't be burdened with a missed acute medical emergency. On the other hand, psych patients can be a burden on the

ED, with the average length of stay in the ED ranging from 15 to 30 hours, depending on whether

or not they require medical clearance and whether or not they're

admitted.

Now, lack of agreement between the ED and the psychiatry department can lead to the adoption

of arbitrary exclusion criteria which delay admission even further.

And what about the cost?

Well, in one study, the total costs were $17,240 U.S. dollars per patient requiring

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