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Acute SI / HI / Psychosis / Mania

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1. Evaluate

For suicidality: .SUICIDEIMASCREEN (Lauren Peccoralo)

This is a brief questionnaire adapted from the Columbia-Suicide Severity Rating Scale (C-SSRS). If you need additional language, a quick internet search for the C-SSRS will be useful. Ideation, Plan, Behaviors, Intent.

Patients respond best to direct language and questions about suicide, and this will not increase suicidal thoughts.

2. Monitor Patient

The patient needs to be attended 1:1 until EMS arrives or decided home is a safe disposition. Review roles below.

3. Assess Risk of Suicidality

For advice, call the Psych ED: 212-241-5637 (x4-5637). This is a direct line to a psychiatrist and can be useful to decide disposition.

4. Arrange Disposition

Home with safety plan: .SUICIDEIMAPLAN (Lauren Peccoralo)

Psych ED: interdisciplinary coordination required

Roles

Triage SW: Reviews provider’s home safety plan with patient. Can be reached by a combined Epic chat to Sandra Misas, Joshua Williams, Ashley Marte. Not available after 4pm and on Saturdays.

MA / LPN / RN: Room Safety Check. Stays with patient until Security or EMS arrives.

Security: Stays with patient until EMS arrives. Cannot restrain. Can be reached by 212-824-7005 (x5-7005).

EMS: 911. Consider requesting for police if ambulance not needed. Police arrive more quickly, can restrain, and walk patients from IMA to Psych ED. Anyone can activate.

Mobile Crisis Team: 988. 8am-8pm: 7 days/week. Evaluates and triages patients at home. Cannot force entry nor care against will unlike EMS. Provider calls.