The ER Treatment Team and Working with the Agitated Patient

This is where working within a disciplinary framework is always essential, and above all, vital in our work in an emergency room. I cannot speak for other social workers in other emergency rooms throughout the New York area, and if you ask other clinicians they may or may not have the same experiences.

I can honestly say it has been an absolute pleasure and honor to work with an essential staff over the last 10 years in the emergency room. We are staffed with two psychiatric residents who rotate every two months, medical students, psychology and social work interns, administrative assistants, four psychiatric attendings, two secretaries, nursing staff, a medical director, a chief resident, and four full-time social workers.

Over the years, I have had the pleasure of supervising a multitude of social work interns from various master’s degree programs and provided them with the clinical knowledge necessary to complete suicide and safety assessments in the emergency room. This, too, has provided me with a sense of clinical fulfillment in training new graduates, as well as licensed masters of social work in the field who come to work in the emergency room. What remains constant is being able to work together as a team to keep not only the patients safe, but ourselves as well.

Everyone plays a vital role in working well together, especially during intense, stressful events when a patient becomes physically aggressive, psychotic, or is under the influence of drugs. Also essential to our staff, is having appropriately trained security personnel and fostering a positive relationship with them so they can assist the clinical staff with the de-escalation of an agitated patient. It is also important to provide security staff with information about the patient prior to their being stationed to watch a potentially aggressive or psychotic patient.

In some cases, it can be a challenge for the psychiatric team when a patient is physically located within another service, such as the medical or pediatric emergency room, and the patient is placed on a one-to-one with security. It is necessary to provide psychoeducation to fellow staff with regard to the patient’s presentation and to always remain cognizant of this point is important.

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