There are lots of potential pitfalls in the assessment of disturbed or psychiatric patients in the ED. The most common are:

Making an initial risk assessment

This should form part of the initial assessment of the patient so that appropriate observation and treatment can be put in place. It will also guide the actions required should the patient leave the department before a full assessment has been carried out.

Not getting enough history

Collateral history will often be needed to make a full assessment. This may involve contacting relatives, the GP and psychiatric services as well as reviewing previous attendances and notes.

Failure to consider other diagnosis

The disturbed patient can be disruptive to the department. Staff and other agencies, e.g. the police, may wish for the patient to be discharged quickly.

A thorough assessment and consideration of organic causes will avoid mistakes.

Alcohol intoxication

Alcohol can alter the mental state of the patient and impair rational thought. If possible, the patient should be sober when assessed. A risk assessment must be conducted when sending home a patient who has presented with mental health issues.

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