No Blue Zone shift is complete without seeing at least a handful of “Psych Eval” patients in the newly minted Blue Obs.
Until the department of Psychiatry starts up an intake process again at Grady we are left with the burden of screening these patients and making a decision as to whether the patient we are evaluating needs psychiatric evaluation and possibly a 1013 legal hold or if they would be more appropriately seen in an outpatient setting.
While there is no simple formula to apply in these scenarios, Michelle Lin (@M_lin), Associate Professor and Chair of Education at UCSF as well as the founder of the blog entitled Academic Life in Emergency Medicine presents her methodology in this post. ALIEM has a very unique and useful feature called Paucis Verbis which is intended to be digital versions of those index cards some of us used to stuff in our whitecoat pockets.
In her post she goes through Dr Orman’s mnemonics “TRAAPEDSILO” and “SAFE” which help identify risk factors for future suicide attempts. The high points are:
Rational thinking loss, specific ideation, and an organized/serious plan are red flags
Awareness, support and engagement are signs of decreased risk
In the end, physician judgement trumps all and truly we are at a crossroads or determining the patient’s risk as well as our own for “missing something”
These are high risk patients that often blend with the homeless and mentally ill which makes our jobs even more difficult.
Do you like Rob Orman’s (@emergencypdx) mnemonic?
Will you use this on shift?
Leave comments or questions, we would love to hear from you!
~ Mene Demestihas, MD