Emergency Psychiatry

Site: Harlem Hospital Center, New York

Certified by the NY State Office of Mental Health as a Comprehensive Psychiatric Emergency Program (CPEP), the emergency service has four service components: (1) the emergency room (er), (2) the extended observation bed unit (EOB), (3) the crisis residence (CR), and (4) the mobile crisis management service (MCMS). The EOB has a complement of six certified extended observation unit beds. The CR has six crisis residence beds off-site for stays up to a week, with the option of transfer to additional beds for extended stays. The ER provides triage, rapid evaluation and stabilization and disposition for an average (in the first half of fiscal year 2009) of four new admissions per twelve hour tour, and approximately 174 per month. This case unit is supported by the MCMS, a team that provides crisis intervention and home-based interventions for patients requiring crisis outreach due to the dangerousness of their clinical situation. Approximately 46% of the ER admissions meet criteria for mica (mentally ill chemical abusing).

  • The required three-month rotation occurs in the first and second years of the residency. The residents progress in both their clinical and supervisory responsibilities as they progress from PGY 1 to PGY 2. There are 2 tours on the ER requiring resident staffing. Residents rotating through the CPEP ER are on duty from 0800 hours to 2000 hours during the day, and 2000 hours to 0800 hours overnight in accordance with Bell Commission requirements. ER Residents are on duty for a total of five rotations, including one night and one day rotation in both the first and second postgraduate years under the supervision of an on-site Attending Psychiatrist.
  • The staffing complement for the three components of CPEP is multi-disciplinary. Residents collaborate in rounds with a multi-disciplinary staff consisting of attending psychiatrists, social workers, community liaison workers, activity therapist, two-three registered nurses per tour, and a physician assistant. This staff is further complimented with addiction counselors, community liaison workers, and psychosocial health technicians.
  • Teaching rounds are documented daily, covering the entire ER caseload. They are conducted by the Chief of Service or her designee. Rounds are a major teaching instrument for learning the objectives of rapid assessment, stabilization and disposition. This clinical experience is supplemented by seminars, case conferences, and lectures. Other in-service/continuing education is provided in a variety of ways. residents receive periodic in-service seminars and ongoing training via the affiliation and the Corporation.
  • The diagnostic categories of these patients were as follows: bipolar disorder, 17.7%; schizophrenia, paranoid type, 18.1%; major depression, 11.1%; schizophrenia, undifferentiated type, chronic, 5.7%; adjustment disorder, 2.5%; substance abuse-induced mental disorder, 9.7%; substance abuse disorders, 21.2%; and other disorders, 21.2%. Criteria for mentally ill chemically abusing status were established for 46% of these patients. This case mix provides a wide variety of clinical experience from late adolescent to the geriatric population for emergency psychiatry clinical experience.
  • The average caseload of a resident is 13 per tour: six new admissions and seven patients carried over from earlier tours.
  • Residents receive two hours of individual supervision from the attendings each week, as well as group supervision from the Attendings.