In this episode of Med Students Over Easy, Patricia is joined by Tanner and guest Mary McLean to discuss the topic of medical holds and what medical students need to know about taking care of patients on medical holds in the ED.
What is a Medical Hold?
Patients can be placed on a medical hold when the EM physician determines that the patient is not able to leave the hospital safely because they lack the capacity to to make decisions for themselves in their current state. The laws that dictate what a medical hold consists of vary from state to state. It is also called different things in different states, but falls under the general umbrella of a medical hold. For example, in Florida, where Mary practices, a psychiatric hold is called a Baker Act, and a hold for a patient impaired secondary to substance use is called a Marchman Act. The reason behind the hold is different, but the functionality is the same.
How do you identify that someone lacks capacity?
Capacity is the patient’s cognitive ability to make decisions and to be able to understand the consequences of those decisions. Capacity is not whether or not the patient is making decisions you would make for yourself or a loved one. Assessing this is within our scope of practice.
How can medical students be safe in the room?
- Keep yourself between the patient and the door.
- Don’t be afraid to bring someone with you to assess the patient.
- Allow the patient to be completely triaged before assessing.
- Keep an eye out for signs that the patient might be escalating, including flight of ideas, clenching their jaw and fists, and refusing to sit on the bed.
- Don’t bring anything into the room that can be used as a weapon.
Take Home Points
- Check your bias at the door.
- Medical holds are different from state to state. Know your state’s laws.
- Capacity is the patient’s cognitive ability to make decisions and to be able to understand the consequences of those decisions.
- Be aware of your surroundings and keep yourself between the patient and the door.
Post by Patricia Capone, DO PGY3
About Our Guests:
Associate Program Director, AdventHealth East Orlando EM Residency Program
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