Keeping Patients at Risk for Self-Harm Safe in the Emergency Department: A Protocolized Approach.

Background: Increasing numbers of patients with psychiatric illness are boarding in emergency departments (EDs) for longer periods. Many patients are at high risk of harm to self, and maintaining their safety is critical. The objectives of this study are to describe the development and implementation of a comprehensive safety precautions protocol for ED patients at risk for self-harm and to report the observed changes in rates of self-harm.

Disparities in Care: The Role of Race on the Utilization of Physical Restraints in the Emergency Setting.

Objective: Race-based bias in health care occurs at organizational, structural, and clinical levels and impacts emergency medical care. Limited literature exists on the role of race on patient restraint in the emergency setting. This study sought to examine the role of race in physical restraint in an emergency department (ED) at a major academic medical center.

"Call Me, Maybe": Supervisor and Resident Comfort With Indirect Supervision in Psychiatry Training.

Background: Resident supervision is critical for education and ensuring patient safety. After hours, communication with attendings is variable.

Objective: The objective was to identify differences among psychiatry residents and attendings regarding the desired level of supervision for issues that arise overnight in the psychiatric emergency department (ED).

Preoperative acetaminophen vs ibuprofen for control of pain after orthodontic separator placement.

Introduction: Pain control during orthodontics is an important aspect of patient compliance. The aim of this prospective, randomized, double-blind clinical trial was to compare the pain control effectiveness of acetaminophen (650 mg) with ibuprofen (400 mg) taken 1 hour before separator placement in adolescents.

Methods: The patients recorded their discomfort on a 100-mm visual analog scale during several activities (teeth not touching, chewing, and fitting back teeth together) and by selecting words adapted from the McGill Pain Questionnaire at 5 time intervals: immediately before separator placement, immediately after separator placement, 2 to 3 hours later, at bedtime, and on awakening the next morning.

The prescription of psychotropic medications for patients discharged from a psychiatric emergency service.

Objective: Considerable debate exists about the value and wisdom of initiating "definitive" pharmacotherapies, particularly antidepressants, in the psychiatric emergency setting. We evaluated the nature and prevalence of medication prescriptions for patients discharged from an urban psychiatric emergency service and the extent to which pharmacotherapy initiation was predictive of follow-through with aftercare.

Method: Records were reviewed for 675 consecutive individuals evaluated and discharged from a community-based psychiatric emergency service over a 3-month period (January 2003-March 2003).