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The Art of Discharge Planning: Aligning Your Goals with the Patient's

Sense of Control, or Not

Just like any other patient with emergency medical needs, the patient with emergency psychiatric needs will also have varying levels of understanding of what to expect from their treatment and time in the ED. The only difference is that sometimes patients with emergency psychiatric needs are kept in the ED involuntarily. Imagine compounding your psychiatric problem—anxiety, psychosis, depression, already a dreadful sense of loss of control—on top of an involuntary hold, and being told that you legally cannot leave the ED until a psychiatric inpatient bed is found for you to be transferred into!

Perception of Loss of Control

We have all been stuck in traffic. Imagine you are in the comfort of your own car and get frustrated at an extra couple minutes or hours of waiting longer to get to your destination. You are tired or hot or bored or have to use the restroom, although you can shift your perception and realize quickly that you have a lot more control of your environment than you initially thought you did! You can turn on the air conditioner or listen to a podcast. Worst case, you can pull over and relieve yourself at the roadside! You can even leave your car altogether and walk away.

We have all had to wait at an airport. Karen, Chris, and I were stuck in an airport going to give a workshop in Halifax, Nova Scotia on ED psychiatry and hospital operations when we were told that our connecting flight in Denver, Colorado had a computer malfunction, and that even after rebooting the computer system several times it still did not work, and we would not be able to board. The airline did nothing more to help us other than give us a business card that included the phone number to address complaints to, and wish us luck finding a connecting flight! We found one that would get us to Halifax, although it would add another 12 hours to our wait. Our emotions ranged from “super upset,” to concerned we would miss the workshop, to feeling anxious about thinking that even if we made the workshop, how jet lagged we would be running into it, to being angry, to then resigning to the notion that we had nothing else to do but wait.

Although we did have many options—we could have gotten on a plane back home and cancelled the workshop. We could have taken a cab to a hotel and made the most of our time in Denver. We could also just stay in the airport, find a nice lounge, and eat at the all-you-can-eat cheese cubes buffet, and try to take naps until the connecting flight.

 
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