24/7 Emergency care & HDU
COMPREHENSIVE PSYCHIATRIC EMERGENCY PROGRAM (CPEP-ASHA)
24/7 Emergency Care
- There is an increase in patients presenting to emergency departments with acute psychiatric crises.
- Although acute psychiatric crises qualify as medical emergencies, the general hospital emergency department might not be the best location of care for these cases.
- What is needed is a comprehensive psychiatric emergency program in the context and location of a stand-alone psychiatric hospital, as most of the general hospital emergency units don’t take the most acute and highly agitated or violent patients.
- The problem is further compounded when such a violent patient has a comorbid physical illness.
To address these treatment gaps, we have started the Comprehensive Emergency Psychiatry Program (CPEP) at Asha Hospital, by establishing an Emergency and Consultation Liaison Psychiatry Department.
The main purpose and functions of CPEP at Asha Hospital
- Excluding medical aetiologies of symptoms and ensuring medical stability.
- Rapidly stabilise the acute crisis.
- Avoid coercion.
- Treat in the least restrictive setting.
- Form a therapeutic alliance.
- Formulate an appropriate aftercare plan.
- The Emergency department works round the clock and accepts the patients 24/7 x 365 days.
- It is staffed at all times by a psychiatrist, nurses, and other ancillary staff trained to handle any Psychiatric and medical emergency.
- The psychiatric emergency department at Asha works in close interaction with the High Dependency medical unit which also operates 24/7 and is staffed with an Intensivist/physician and other supporting staff and located in the same premises.
- Those who are stabilised in an emergency room if required are admitted into the inpatient unit of the hospital.
The role of standalone psychiatric emergency services as safe, efficient and patient-centred facilities is well documented across the world and the CPEP at ASHA provides the much needed service in the area of Emergency Psychiatry.
EMERGENCY AND CONSULTATION-LIAISON PSYCHIATRY DEPARTMENT: SCOPE OF SERVICES
- The only 24 hour exclusive emergency and consultation-liaison psychiatry department in the city manned by qualified psychiatrists round the clock
- Management of psychiatric emergencies including :
- Drug withdrawal or intoxication.
- Medical emergencies presenting with behavioural symptoms.
- Panic attacks
- Acute behavioural disturbances
- Availability of observation facility at nominal charges in the emergency psychiatry department itself.
- Liaison with attached ICU with visiting specialists from all departments for diagnosis and management of behavioural emergencies due to underlying physical conditions.
- Management of mild to moderate medical comorbidities in patients with psychiatric problems.
- Liaison with 2 general hospitals for Management of severe medical comorbidities with staff from our hospital visiting these centres thereby enhancing continuity of care.
- Visits to various general hospitals to assess psychiatric emergencies and a need for shifting to our specialist psychiatric centre.
- Availability of a depot injection clinic for administration of long-acting injectable medications.
Patients with mental health issues develop medical co-morbidities like hypertension, diabetes, liver, renal, endocrine, metabolic disorders and many more. But it worsens as their mental health deteriorates due to several reasons, ranging from stopping the medicines which are used to treat those, disturbance in diet and many more . Initially these patients were either deferred from being admitted or referred to a general hospital following admission, as we were unable to provide a 24 hour optimal medical care. The High Dependency Unit (HDU) of Asha Hospital was started in 2020 with the aim of providing medical care to in-patient psychiatric patients who are suffering from such medical issues or who developed sudden emergencies while inpatient in wards. So that any patient who comes to our hospital shall not return dissatisfied due to lack of proper care and evaluation.
The HDU is a 24 hour operational unit under the care of the Iris Critical Care Team, with one critical care specialist available at all times along with a team of competent critical care nurses. Any medical complications arising in the in-patients are assessed and managed in the ward and if necessary are shifted to the HDU suite. The HDU suite is well equipped with the following
- 5 beds- each bed has a monitor attached for continuous vitals monitoring
- Oxygen supply available 24 hours
- Ventilator (both invasive and non-invasive ventilation)- kept available for 24 hours and ready in case of any requirement.
- Defibrillator- of high end quality to manage any cardiac issues
- Crash cart- well stocked with all required emergency medications and emergency devices
- ABG machine- for rapid assessment of metabolic/ respiratory conditions
- Emergency Medicines- like antibiotics, inotropes, antihypertensives, antiarrhythmics, IVelectrolytes, nebulization respules, to name a few, kept well stocked to manage any medical emergencies which can arise.
The HDU unit has a liaison with consultants of the following departments, who respond promptly when called upon and if requested visit the hospital for providing their valuable inputs-
g) General Surgery
l) Internal Medicine
The psychiatric management of the patients admitted in the suite is managed by the team of Emergency Psychiatry which has one fully qualified psychiatrist available 24 hours. The team can aid the HDU in prompt management of behavioural disturbances and any relevant management of psychiatric patients when admitted to the suite.
Our patients now need not be worried about their medical issues when they visit our hospital as they can get a holistic approach towards their care in both mind and body.
Some of the common medical issues managed by the HDU :
1) Hypertensive emergencies
2) Cardiac emergencies
3) Metabolic & electrolyte abnormalities like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, diabetic ketoacidosis etc
4) Hepatopathy and pancreatitis
5) Delirious behaviour due to alcohol withdrawal and any other medical issue
6) Surgical issues like diabetic foot, fractures and physical injuries
7) Neurological conditions like Parkinson’s and head injuries
8) Suicide attempts/Self-harm attempts
9) Infections like urinary, respiratory, gastro-intestinal and sepsis