Evaluating the Impact of Patient Management Policies in Walk-In Clinics for High-Risk Patients

Case Overview

This case study examines a 36-year-old adult with a complex psychiatric history, including substance abuse, recurrent relapses, and suicidal ideation. A suspected drug overdose led to the patient’s admission to an Emergency Department (ED) shortly after discharge from a treatment center. Following multiple Naloxone resuscitation doses, the patient was released the following day with an appointment at a walk-in clinic.

After arriving at the clinic while on the phone with their California-based doctor for prescription refills, the patient was turned away without reviewing their crisis evaluation, which identified them as high-risk.

Tragically, the individual died shortly thereafter. The case raises important questions about walk-in clinic policies regarding patient management and how these protocols should be adapted when dealing with high-risk individuals.

Questions to the Emergency Medicine expert and their responses

How often do you treat patients at a walk-in clinic?

As part of my role, I work both in our urgent care walk-in clinic and emergency department. I encounter similar patients weekly.

What clinical factors should be considered when determining if an individual should be turned down at a walk-in facility?

In my professional experience, any patient presenting with a past psychiatric history and substance abuse requires special attention. In this particular case, given the patient’s history of multiple relapses and previous suicidal ideation, it is evident that they were high risk. They should not have been turned away.

About the expert

This expert brings over three decades of experience in emergency and family medicine, with a focus on managing high-risk patients. They are board-certified in family medicine and maintain active memberships in the Association of Emergency Physicians and the American Academy of Family Physicians. Currently serving as an attending physician in an emergency department at a VA medical center and as an assistant clinical professor of family medicine at a prominent Pennsylvania university.