Emergency Psychiatry Service

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.

Important note:

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 and your child questions and briefly examine your child. Before you arrive in the Emergency Department, your child's primary care provider or specialist may have called to tell us about your child and their condition.

After triage, most patients with mental health emergencies are brought directly into an exam room. An Ambulatory Service Representative will come to your child's exam room to register them as a patient in the Emergency Department. 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. Ambulatory Service Representatives and the Emergency Psychiatry Service 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 the bill yourself. Your child may be referred to a psychiatric facility that is covered by your insurance. We will not send your child until they are medically stabilized. If you do not have insurance or have questions about your 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 Emergency Department for a psychiatric evaluation are placed on one-to-one observation. A care companion 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 their time in the Emergency Department.

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 them and come up with an appropriate method of treatment.

Recommendations for follow-up care are made by our staff in conjunction with the medical team in the Emergency Department.

Treatment recommendations may include sending your child home with the appropriate outpatient and community resources or inpatient psychiatric hospital. If the higher level treatment options are not available, your child may stay in the Emergency Department while we find the right treatment program for your child. Your child’s team (including pediatric and psychiatric clinicians) will see your child daily. This process of awaiting a higher level of care is called ‘boarding’ Our goal is to help your child access care in the least restrictive and safest environment based on their individual needs.

For more information on the levels of psychiatric care, download this family education sheet.

The doctor or nurse will usually give you printed instructions when your child is ready to leave. The Emergency Psychiatry clinician will also give you instructions or referrals for follow-up care.

If you have any questions after you leave, call Boston Children's Division of Emergency Medicine at 617-355-6611. You may also call your child's primary care provider. The Emergency Department sends 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.

• 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 down the hall from the CVS Pharmacy
• 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.