New ER protocol better supports youth in crisis

Recent Canadian research has shown that visits to Canadian ERs for mental health crises for youth age 0 to 24 has increased by 45% over the last nine years. For the ten to 14 age-group, the increase has been 68% over the same time-period. 

To better support these patients, an ER protocol is being piloted and evaluated for efficacy in five BC health authorities. The protocol helps ER staff provide standardized, best practice care for all children and youth in BC who present in the ER with a mental health or substance use crisis.

In partnership with Interior Health, the protocol was introduced last February at Williams Lake hospital’s ER, and in June at the Smithers, Cranbrook and Invermere ERs'. The protocol will trial at Interior sites until October, to allow time for staff to apply and gain confidence with its tools. It will be introduced for testing in two to three ERs in each of the five health authorities in the coming months.

Protocol Tools

The protocol includes four components:

(1) a pamphlet for youth and family on ‘what to expect’ and community resources

(2) an algorithm, with assessment tools, to guide the ER staff

(3) a discharge communications plan to link the child or youth back to their GP and community referral services, and

(4) a safety plan so that on discharge the family know what to do if the crisis recurs.

Dr. Jeff Peimer, a Williams Lake ED physician, is the ER lead on the working group that has been developing the protocol for the last three years. He has traveled to Cranbrook, Invermere and Smithers to meet with doctors, crisis response team workers, nurses, ER staff, and community referral agencies at the pilot sites. Feedback from all these groups has led to significant changes to improve the protocol.

"We welcome the feedback," says Dr. Peimer. "Our goal is to make it easy for staff to use, to save time and to improve decisions on management. If it looks like more work or is too time consuming, the ERs won't use it. Using the protocol it should take an ER physician 15 minutes to gather enough relevant information to make an educated decision about a child’s future.”  

How to use the protocol

Information and training sessions on the ER protocol have been taking place around the province and include site visits, web-training and teleconferences. Three hour-long workshops, complete with guided role play scenarios, have been held in Williams Lake and Smithers. Arranged by the Local Action Teams in each community, the workshops have been well attended by people from both the hospital ERs and the community: 90 people in Williams Lake and 60 people in Smithers. Each health authority is developing training for its pilot sites.

The ER protocol is spearheaded by the Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative, a partnership of Doctors of BC and BC government. For more information on the protocol, please contact: