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Children with psychiatric illness seek care in general emergency rooms for many reasons, including the lack of access to outpatient services that might obviate the need for such visits. Once these children arrive, they stay for long periods of time, often in uncomfortable and frightening quarters, due to lack of inpatient beds, or other residential services or day programs. Their problems range from conduct disorder to psychosis, from social disaster to abuse and neglect. Evaluation and management is time-consuming and labor-intensive. In this symposium, each presenter will address the singular aspects of caring for these children within the emergency department setting, with a focus on how emergency departments might redefine care strategies, particularly in response to changes in health care law. Dr. Leslie Zun will open the discussion with a description of the realities of managing children with acute psychiatric problems within the emergency department of a general hospital. Dr. Sandra Rackley will describe the problem of pediatric "boarders," and ways that emergency room staff, in conjunction with hospital administrators, can manage the burden imposed by such long lengths of stay. Dr. Daphne Korczak will present data addressing the reasons that emergency medicine physicians refer their pediatric patients for psychiatric assessment within the emergency room setting, including diagnostic impression and disposition following psychiatric assessment of these patients, and parental satisfaction with an alternate model of psychiatric service provision. Dr. Maryland Pao will talk about whether or not every child who presents to an emergency room with a psychiatric crisis should be screened for suicide. Dr. Laura Markley will review novel drugs of abuse and offer considerations in the assessment and management of intoxicated adolescents. Finally, Dr. Laura Prager will present some specific case examples that highlight the difficulties emergency department staff face when dealing with children and adolescents with psychiatric illness, including the potential lack of access to child and adolescent psychiatric consultation within the hospital, medical problems masquerading as psychiatric illness, system failures, and, last but not least, the intangible factors that attend development.
