Emergency room psychiatry

Emergency psychiatry is a relatively new specialty that raises specific threats of liability for providers. Emergency department (ED) providers must address a broad range of conditions including psychotic disorders, mood disorders, substance use disorders, medical comorbidities, acute agitation, feigned illness, and a wide range of social stressors. Among the distinctive factors contributing to this risk of liability are the fast pace and brief duration of physician-patient encounters, frequent changes of shift, limited opportunities to obtain background and collateral information about patients, and an absence of specialized training for physicians. Areas of particular risk include wrongful admissions, negligent discharges, suspected malingering, and matters related to confidentiality and reporting. Clear documentation is essential in avoiding liability and should include a specific chain of interaction and appropriate safety planning. Providers should be familiar with the laws in their jurisdiction and should consult the hospital legal team for additional guidance when needed.