IN ERROR BELOW*

This week’s case highlights the dilemma of being the sole overnight provider in an ED without SW or child psychiatry immediately available. Although the patient has some protective factors, she also has a few troubling features. It can be challenging to determine how much risk you are willing to accept when making a plan for disposition.

In practice – since it was 2 am, I could not call the outpatient psychiatrist who might have had further insight. I ended up keeping them overnight with me to make sure her abdominal pain improved. In the morning, SW was able to get hold of the patient’s outpatient psychiatrist in conjunction with the ED psychiatrist to create a safety plan that was feasible for the family and agreeable to the patient. 

Several months later, she attempted to overdose with another OTC medication and did need psychiatric admission inpatient once she was medically cleared. 

The information in these cases has been changed to protect patient identity and confidentiality. The images are only provided for educational purposes and members agree not to download them, share them, or otherwise use them for any other purpose.