EMed

Transfer of patients from ED to an off-site Psychiatric Unit

Before Transfer

Print version generic transfer.

  • The decision for transfer (for admission / further assessment) of a patient to a local mental health care unit is identified following mental health assessment of the patient by a Psychiatrist (liaison or on-call) in the ED department. This is documented in the medical notes
  • Prior to transfer the patient is considered medically fit for discharge from ED by the ED Doctor and same documented in the patients ED notes
  • The Psychiatrist (liaison or on-call) in the ED must call the relevant: Psychiatrist (or responsible person) in the receiving mental health care unit to discuss the patient status. This discussion must include the reasons for transfer along with needs, risks and whether the patient needs accompaniment by ED staff prior to transfer. This must be documented in the patient medical notes
  • The Psychiatrist (liaison or on call) discusses with the Clinical Nurse Manager (CNM)/Lead nurse in the ED about planning the transfer of the patient to the mental health care unit
  • The Psychiatrist (liaison or on call) in conjunction with the CNM or the designated Lead Nurse in ED must decide who should escort the patient to the mental health care unit
  • In certain circumstances and if deemed appropriate by the Psychiatrist (liaison or on call) the patient’s family may bring patients to the receiving unit
  • If transferring a female patient at least one member of the transport team must be female
  • The CNM or the designated lead Nurse in ED informs the patient’s family/carers of the transfer and requests them to follow the patient to the off-site mental health care unit
  • Transport arrangements for patients that require an ‘assisted admission’ under the Mental Health Act, 2001 must be organised by contacting the receiving mental health unit. The receiving mental health unit will provide information about this
  • If it is likely that the patient will require psychiatric admission, and the receiving psychiatric unit have no beds available then the following applies:
    • The patient will remain in the ED for a maximum of 6 hours before re-assessment by the Psychiatrist (liaison or on-call)
    • Following re-assessment after 6 hours, the Psychiatrist (liaison or on-call) in CUH will call the Psychiatrist in the receiving mental health service site again. The purpose of this phone call will be to arrange a scheduled time of transfer to and reception by the receiving mental health service site for further psychiatric assessment and management. Patients with acute mental health needs must not remain in Emergency Departments any longer than is absolutely necessary
    • Immediately prior to transfer the nursing and psychiatric staff in the receiving unit will again be alerted to their pending arrival by their counterparts in the ED

Checklist for transfer from ED to an Acute Mental Health Unit (MHU) in Cork

  1. Mental Health assessment has been carried out by a Psychiatrist (Liaison or On-call) in ED
  2. EM Doctor has confirmed patient to be Medically Fit for discharge from the ED
  3. Psychiatrist (Liaison/On-call) in ED has discussed with relevant psychiatrist/responsible person in receiving MHU
  4. Psychiatrist (Liaison or On-call) and duty Clinical Nurse Manager (CNM) in ED have together discussed transfer procedure including mode of transport and specialling needs during transfer
  5. CNM in ED has informed the patient's family/carers of the transfer and has requested them to follow patient to the MHU
  6. ED CNM has spoken to the CNM in the receiving MHU to agree an appropriate time of transfer to and reception by the MHU staff
  7. A copy of the Mental Health assessment completed by the Psychiatrist (Liaison or On-call) to accompany the staff member escorting the patient
  8. A copy of medical and nursing notes from the ED chart to accompany the staff member escorting the patient
  9. The ED Nurse escorting the patient during transfer is aware of the need to provide a verbal handover and a handover of relevant documentation to the receiving CNM on the MHU

Mode of transfer

Mode of transfer
Patient Escort Mode of transport
High risk behavioural disturbance

INVOLUNTARY
  • Assisted admission team
  • Assisted admission vehicle with assisted admission team
  • or
  • Ambulance or Intermediate Care Vehicle (ICV) with paramedic and RGN/RPN/Medical practitioner when assisted admission team is unavailable
Moderate to high risk behavioural disturbance

Voluntary/Involuntary

Including
  • For admission to psychiatric unit
  • Has acute disturbance of mental state
  • Sedated prior to transport *
  • Has capacity to consent to transport
  • RGN
  • or
  • RPN
  • or
  • Medical practitioner
  • Ambulance with Paramedic
  • or
  • ICV with EMT (not paramedic)
* Note: Patients who are sedated should only be transported in an ICV with the appropriate resuscitation equipment and RGN/RPN/Medical escort
Low to moderate risk of behavioural disturbance

Voluntary

Including:
  • Has capacity to consent to transport and admission
  • Not sedated at time of transport
  • RGN
  • or
  • RPN
  • or
  • Medical practitioner
  • Ambulance with paramedic
  • or
  • ICV with EMT (not paramedic)
Low risk of behavioural disturbance

Voluntary

Including
  • No acute disturbance of mental state
  • Low risk of harm to self or others
  • Not sedated at time of transport
  • RGN
  • or
  • RPN
  • or
  • Medical Practitioner
  • or
  • Competent carer
  • Private transport with competent carer
  • or
  • * If transfer is on CUH campus only, porter provided or security provided transport vehicle for low risk transfers only
* for low risk transfers on the CUH campus only: Porter-provided transport: 07:30-19:30; Security-provided transport 19:30-07:30

Transfer

The following documentation must accompany the patient to the receiving unit:

  • A copy of the psychiatric assessment completed by liaison or on call psychiatry
  • A copy of both medical and nursing notes from the ED chart

The CNM or designated lead Nurse shall contact the Nurse in Charge of the Mental Health Care Unit to inform them of the impending transfer and give a comprehensive nursing assessment which includes the patient’s needs, risks and the person who will be accompanying the patient.

On arrival to the receiving unit the escorting nurse must give a verbal handover of the patient condition. The documentation is given to the nurse in charge of the mental health care unit. This completes the transfer of the patient into the care of the psychiatric services.

If a health care assistant (HCA) escorts the patient to the mental health care facility the CNM or the designated Lead Nurse in ED must ring the receiving unit and give full verbal handover on the patient. The documentation is given to the nurse in charge of the mental health care unit by the HCA. This completes the transfer of the patient into the care of the psychiatric services.

CUH to AMUH transfer only

Print vform CUH to MHU transfer only

Content by Prof Eugene Cassidy, Dr Íomhar O' SullivanPrint version generic transfer. Last reviewed by ÍOS 12/04/23.