Recommendations for doing Zoom ER/CL Consultations

(When Necessary)

**this is unlikely to be used given most patient encounters are required to be done in person given end of Public Health Emergency**

1. Interviewing
   • When you are ready to see the patient, check the ER board or “Care team” for the phone number of the Nurse (usually a 5 digit extension starting with 7) and call using 310 267 xxxx. Let the nurse know that you are ready to see the patient, and have your Zoom room open with Meeting ID handy to provide to Interview the patient and/or parent via iPad together or separately as is appropriate
   • Patients must be seen via iPad, but it is okay to call parents on the phone if that makes collecting collateral less of a logistical problem, or if parents are not on
   • For day call, if you know that the attending will be free to see the patient with you, it is sometimes helpful to have the waiting room This will allow you to place the patient in the waiting room while you staff with the attending, and allow them to easily see the patient with you after staffing, saving you another zoom call. This step is unnecessary for evening call shifts as your staffing will be over the phone with the overnight attending.

2. Documentation
   • Largely the same as in person consults, use the same “.PSYEDCLNOTE” templates
   • Within your note use the dot phrase “.psytele” to document that the meeting was done over video conferencing or audio conference
   • It is often easy to see the patient and write your note simultaneously while interviewing on Feel free to do so, but be mindful if this is distracting you or limiting your ability to collect information.
   • If the attending saw the patient with you on Zoom, be sure to update the bottom signature to say “seen and discussed with attending Dr. ”

3. Consents (Voluntary admission and Psychotropic medications)
   • This only applies to patients being admitted to RNPH (both CL and ER). In order to be admitted, a person needs to be signed in voluntarily or on a 5585 72hr

In most cases, a parent will sign them in voluntarily and for remote consults this must be done digitally.

• For the digital version, make a new note, select “Legal” for note type and in the “Insert smart text” box (with the red and blue boxes), type “Psy tele” to find the digital telephonic consent form and fill it On this form you will also need to have a second staff member witness and electronically co-sign it by adding them as a co-signer. This form can simultaneously be used to consent for both medications and for voluntary admission. Your witness can be the ER sitter, the ER Nurse, a member of your team, or even the accepting RNPH nurse (have them call in using the phone numbers associated with your meeting), just so long as they are able to listen to the discussion noted in the telephonic consent.

4. Orders
   • In the ER, this is the same as normal call protocol. After placing

discharge-readmit orders, do not page the CWA with a bed number until COVID negative. Once it is back to you (or if several hours later, the R3) and COVID negative, then page CWA with the bed number.

• On CL, you are not placing orders, only making recommendations to the primary team, so no changes to protocol.

5. Medical clearance
   • An ER patient is not considered medically cleared until their COVID results are back and negative. Don’t forget to be on the lookout for other medical comorbidities that may make psychiatric hospitalization unsafe
   • When an ER patient has been medically cleared, it is appropriate to sign the discharge readmit orders, then call Central Work Area (x78407) to give them the bed assignment. In many cases these steps will be done by the on call R3.
   • On CL, transfers to the inpatient psychiatric unit will depend on medical clearance by primary team and discussion with Inpatient Attending.

6. Physical exam / CN exam / ROS
   • Any patient admitted to RNPH will need a documented physical exam, review of systems and Cranial nerve exam. If the ER service is remote, use the physical exams documented by the ER residents.
   • When it is confirmed that the patient will be admitted, it is appropriate to let the ER resident know about the admission and if they have not yet documented these sections, you can let them know that they are required for admission.
   • CL patients typically do not receive physical exams from our team, though this should be considered on a case by case basis and there are times when an in person physical exam may be appropriate (ie: assessing for EPS, oculogyric crisis or catatonia). Review this with the attending to determine a plan for how to proceed.

7. Visitation rules
   • If considering an admission to psychiatry from ER or CL, review the current inpatient visitation rules with the Many families will find the limitations to be a deal breaker for admission, especially if in-person visitation is restricted.
   • Visitation rules are regularly changing and can be as restrictive as to disallow any in person visits (but Zoom visits are possible) and limited clothing and objects allowed on the Remind families that these policies are subject to change and a more liberal visitation policy on admission may change at a later date.