In the the Emergency Psychiatry Service at Boston Children's Hospital, we see more than 1,000 children and teens, ages 3 to 18 years old, every year after they are brought to the emergency room at Boston Children's Division of Emergency Medicine.
The children and teens we see are usually brought to the emergency room because they are in crisis and need immediate assistance from a mental health professional.
Triage is the process of evaluating the seriousness of a patient's illness or injury. When you first arrive, you and your child will be seen by the triage nurse. This registered nurse is specially trained in pediatric emergency care.
It is important to give all requested information to the triage nurse. If your child has a life-threatening or very serious illness or injury, he or she will be seen by a doctor right away.
Even if your child is showing obvious psychiatric distress, he or she will still have a medical evaluation before a psychiatric evaluation. This is to rule out any medical conditions that could be confused with a psychiatric condition.
The nurse will bring you and your child to an exam room in the triage area. The nurse will ask you some questions and check your child's temperature and weight. He or she will also briefly examine your child. During the busiest times, the sickest children are seen first. Other families are asked to wait.
Before you arrive in the Emergency Room, your child's primary care provider or specialist may have called to tell us about your child and his or her condition.
After triage, most patients with mental health emergencies are brought directly into an exam room. An Ambulatory Service Representative (ASR) will come to your child's exam room to register him or her. The ASR will ask you questions, such as your address and telephone number. It is important to give complete information. This helps us contact you or your child's doctor about your child's care.
Insurance companies often require us to obtain approval for emergency visits. ASRs and psychiatric clinicians both work to obtain approval for both the medical and psychiatric component of your child's visit.
We are available to treat your child even if your insurer does not approve the visit. You will be asked to pay for the bill yourself or we will refer you to another psychiatric facility that is covered by your insurance. We will not send you until your child has been stabilized. If you do not have insurance, our financial counselors can help you.
You will be asked to wait in the waiting room if an exam room is not available. There are some toys and a TV tuned to children's programs. A child life specialist is available during the evening to offer activities for your child while you wait.
The triage nurse may tell you not to give your child anything to eat or drink while waiting. Please follow these instructions.
As soon as possible, you and your child will be brought to an exam room. A team of doctors and nurses will care for your child. There are senior doctors, called attending physicians, who supervise care in the Division of Emergency Medicine.
If your child has blood tests, X-rays or other tests, it may take an hour or more to get the results. Please be patient. You may be asked to return to the waiting room during this time.
A parent or guardian must stay with his or her child at all times. Two family members may stay with the child in the exam room. Other family members may stay in the waiting area.
Often patients who come to the ER for a psychiatric evaluation are placed on one-to-one observation. A sitter or security guard may be asked to stay either inside or directly outside of your child's exam room. One-to-one observation helps ensure your child's safety during his or her time in the ER.
The Psychiatric Evaluation
Once your child has had a medical evaluation and has been referred to our team, we will provide your child with a psychiatric evaluation. We will evaluate your child's condition, try to stabilize him or her and come up with an appropriate method of treatment.
Recommendations for follow-up care are made by our staff in conjunction with the doctor in the ER.
Treatment may include inpatient hospitalization or outpatient services at Children's or another psychiatric facility.
The doctor or nurse will usually give you printed instructions when your child is ready to leave. Our staff will also give you instructions or referrals for follow-up care.
If you have any questions after you leave, call Children's Division of Emergency Medicine at 617-355-6611 or contact the psychiatric clinician-on-call at 617-355-6369. You may also call your child's primary care provider. We send a copy of the record from the visit to your child's primary care provider right away. It tells the provider what was done for your child and what was recommended.
Answers To Common Questions
The registration clerk will stamp parking tickets for the Boston Children's garage. This garage is directly across the street from the main driveway to the hospital. Families with stamped tickets pay a reduced fee for parking.
There is a smoking area outside the hospital doors and to the left, near the ambulance entrance. No smoking is allowed anywhere inside the hospital.
Restrooms are located in the waiting area. If the restrooms need supplies or cleaning, please let one of the triage nurses know. Diaper changing stations are located in the men's and women's room.
There are bank machines on the first floor across from the Fegan Registration area.
There are two telephones in the area near the exam rooms for patients and families to make local calls at no cost. Please keep the calls short. There are also two pay phones in the waiting area.
During your visit to the emergency room, if you have questions or concerns that your child's doctor or nurse cannot answer, please ask to speak to the attending physician or charge nurse.