Harbor:Psych patients

• Exodus Psychiatric Urgent Care
  • Acute side is open 24/7
  • Outpt side (for med refills, etc) is generally open 8a-4p (dependent upon provider availability)

• Initiating the transfer from Exodus to the AED or PED for medical clearance:
  • Exodus Charge RN calls the ED to initiate transfer (call both ED physician and ED nurse).
    • Adult Attending (x66902 or x66906 as backup) or PED attending (x66910 or PED Sr. Resident x66911 as backup)
      • Attending places a pre-arrival note (include the reason for medical evaluation, presence of 5150, and any safety concerns).
    • RME Charge for adults (x66950) of PED Charge for pediatric patients (66960)
      • Can call Overall Charge x66930 as backup for all patients
      • Notify RN if the patient is on a hold so a sitter can be identified.
      • Note any patients that are safety risks (high flight likelihood or history of aggressive/violent behavior) so Golden Hand can be placed.

• • Exodus will transfer the patient to the ambulance entrance of the ED via wheelchair or van with both a nurse and security officer
    • Exodus staff will then take the patient directly to triage (to the adult ED for 21 and older and to the Pediatric ED for 20 and under).
    • In the AED, the reassessment RN will be the designated receiving triage RN, but the patient can be seen by any triage team that is available.
    • If applicable, the original hold (5150 or 5585) documentation will accompany the patient.
    • After handoff to the triage RN, Exodus staff will be released.

• The patient will be evaluated by the triage team with pertinent orders placed or by the senior resident in the PED then taken directly to a room with a sitter. Any necessary tasking will occur in the ED room.
  • If there are no available rooms in the AED, tasking can occur in RME and the patient will stay in RME 12 with a sitter until a private room is available.
  • If there are no rooms available in the PED, the patient will remain in triage until a room with a sitter is made available.
  • During the process of medical evaluation, the ED provider may consult Psych for any reason (medication recommendations, concern due to a change in behavior, etc.).

• Discharging patients back to Exodus
  • After the medical evaluation is completed and the patient sent from Exodus is medically cleared and deemed stable for psychiatric assessment and not a flight or safety risk, the patients will be discharged back to Exodus.
    • The treating nurse will call the Exodus Charge RN (424.405.5888)
    • The clerk will print a “transfer packet” (do not need the EMTALA form)
      • Providers: try to complete the physician documentation so the Exodus staff can see what was medically addressed and view your MDM
  • Exodus staff (RN + security) will transport the patient back to Exodus.

• • If there is any safety or elopement concern, or there is no longer space at Exodus, the patient will be transferred to the Psych ED.
  • At their discretion, Psych may initiate a Sheriff-accompanied transfer to Exodus.
  • Any patients INITIALLY presenting to the Adult ED needing psychiatric evaluation should be sent to the Psych ED where they may then be triaged to Exodus.

Dr. Chappell & Melissa Trejo (Exodus Asst. Director) 9-12-2022