A Recommended System for Psychiatric Emergency Room

Resident and Faculty Backup

by John Tennison, MD, Chief Resident Physician, 2002-2003, University of Texas Health Science Center, San Antonio, TX


    The backup system elucidated in the flowchart below has been utilized and found to be effective at the University of Texas Health Science Center in San Antonio.  As can be seen from the flow chart, the Psychiatric Emergency Service (PES) resident would normally call a PGY2 or PGY3 backup first for general advice.  If the PES resident determines that another resident is needed in the psychiatric emergency room to insure adequate patient safety or management, the PGY2/PGY3 backup is also the first line of defense.  If for any reason the PGY2/PGY3 backup system fails, the PES resident would then call the second line of defense in the backup system, in this case a PGY4, who may also be physically called into the emergency room, if necessary.  If the PGY4 backup system fails or cannot adequately address the needs of the PES resident, the third line of on-call defense becomes the faculty on call.  In addition to these three levels of backup, the PES resident may call one of two Chief Residents, one of three PES faculty, or one of two Residency Training Directors if, for any reason, the three-levels of backup fail.

   In addition to this three-tier backup system, a dedicated child and adolescent faculty psychiatrist is also on call to check out any and all patients who are 18 years or younger.  This faculty member is expected to be called before discharging any patient 18 years or younger from the psychiatric emergency room.

   The flowchart below is a single graphic file which may be copied and posted freely wherever it might enhance patient care.

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