MGH: Acute Psychiatry Service

Christine Finn

Patient Population

The Acute Psychiatry Service, or APS, has several functions. First, it is a Boston Emergency Services Team (B.E.S.T.) site providing emergency evaluations for acutely ill or in crises patients. Patients may arrive as “walk-in” or voluntary patients and be seen in the clinic that operates out of the APS from 10:00am-9:pm on weeknights, and 9:00am-5: 30pm on weekends; Patients may also be sent to the APS on an emergency section 12 “pink papers” which mandates evaluation for judgement and behaviors which may endanger the patient or others. The APS is structured so that the patients may wait in an unsecured waiting area, a secured waiting area or in locked holding rooms. Patients may also be located in other parts of the emergency room based on the patient’s medical needs or the capacity of the APS. APS residents also provide consultation to the rest of the emergency room as needed. Disposition of patients involves outpatient scheduling of follow-up, follow-up in the APS, and inpatient hospitalization.

Team Organization

Four PGY-II residents join the APS team for 3 month rotations. The permanent APS team consists of the following members: the chief of service-Dr. Kathy Sanders, 8 attendings who do half-day shifts in the APS, one PGY-IV chief resident, APS RN’s, PCA’s, social workers, psychology interns, medical students, security and front office staff. All members of the team divide up coverage of the patients who are in the APS at any given time. The PGY-II residents are given the responsibility for organizing the team during the daytime and overnight shifts to ensure proper patient care.

Rounds

Mandatory APS “board rounds” occur twice daily at 10am and 6pm, 7 days a week. At that time all the current and anticipated patients are reviewed and responsibilities for their care are divided among team members.

APS teaching rounds occur from 8am-10am on Mon, Tue, Thur and Fri and 9-10am on Wed, Sat, and Sun. Teaching rounds are led by adult and child psychiatry attendings and senior residents and include a review of the previous night’s cases and formal didactics.

Call

While on the APS rotation, PGY-II residents are on call overnight every fourth night from Sunday-Thursday. The post-call resident leaves the hospital the next morning at 10am following rounds. Friday and Saturday nights are covered by the PGY-II residents on the Blake 11 rotation. Senior residents are responsible for weeknight and weekend day coverage.

Documentation

Documentation in the APS is done using the EDDS system on the computer. A template of a psychiatric interview is provided and residents type their assessments and physical examinations. Consultations to other parts of the emergency room are written on APS consultation progress notes. Attendings will also write notes on the patients that they supervise. All patients are to be presented to attendings during the daytime shifts. If an attending is consulted on cases overnight, the name of the attending should be documented in the APS note. Old APS assessments are available on EDDS.

Vacations

Each PGY-II resident will take one week of vacation during the APS rotation. The dates of this vacation may not fall on the first or last weeks of the rotation. Only one PGY-II may be away during any given week. The dates of vacations will be decided during the first week of the rotation to allow the arrangement of senior coverage of the APS during the PGY-II’s vacations.