Guide

The ED handoff: call ahead, send paper, follow up

Summary

Sending a client to the emergency department without losing the thread is a five-part handoff: decide the ED is the right level of care, call ahead so they are expected, send a concise written clinical summary and the safety plan, arrange safe transport, and calendar the follow-up before they leave your care. The thread holds when each step is documented and the loop is closed after discharge.

By Gale Editorial · Updated 2026-07-26. Every figure cited to a dated source. How we write.

How do I send a client to the ED without losing the thread?

Treat it as a handoff, not a discharge. Decide the emergency department is genuinely the right level of care, then call ahead so the client is expected, send a concise written summary and the safety plan, arrange transport that matches the risk, and set the follow-up before they leave your care. Losing the thread happens when a step is skipped or left undocumented.

A referral to the ED is one of the highest-stakes transitions in outpatient practice, and for a solo clinician there is no case manager to carry the pieces. The session that becomes a crisis can move quickly from assessment to disposition, so having a standing handoff routine — whom you call, what you send, how you follow up — means you are executing a plan rather than improvising under pressure.

Deciding the emergency department is the right level of care

The ED is the right destination when the risk is acute and immediate — imminent danger to self or others, a medical component to the crisis, or a need for monitoring and evaluation that outpatient care cannot provide today. A structured risk assessment such as the Columbia-Suicide Severity Rating Scale helps distinguish acute risk that needs the ED from chronic risk that a safety plan and closer follow-up can hold 1.

Not every crisis belongs in an emergency department. Mobile crisis teams, urgent outpatient contact, and a strengthened safety plan are often the better-matched response for a client who is distressed but not in immediate danger. Documenting why the ED was — or was not — the right level of care is part of the decision, and it is what makes the disposition defensible if it is questioned later.

Calling ahead: what the emergency department needs to hear

Call before the client arrives so they are not walking into a cold intake. In a brief call, give the ED your clinical picture: the reason for referral, your risk assessment and its basis, relevant history and current medications by name, what precipitated today's crisis, and your direct contact information. A warm handoff shortens the client's wait and prevents the story from starting over from zero.

The goal of the call is continuity: the receiving team should know what you know. Keep it focused on what changes their decisions — the acute risk, the safety concerns, and how to reach you. Name medications but never a dose; the ED will confirm the regimen directly. If the client is a minor in crisis, coordinate with the parents or guardians who will be present, since they are part of both the handoff and the consent picture.

Sending paper: the written handoff

Follow the call with something the ED can put in the chart. A concise written summary — the reason for referral, your risk assessment, the safety plan, current medications by name, and your contact information — travels better than a phone call alone and survives the shift change that will happen before the client is seen. The safety plan you built with the client should go with them.

The safety plan is not just a therapeutic tool; it is handoff data. The Stanley-Brown safety planning intervention's structure — warning signs, coping strategies, supports, and means restriction — tells the receiving team what has already been put in place and what to reinforce 5. Sending it prevents the ED from rebuilding from scratch and gives the client one consistent plan across settings rather than two competing ones.

Transport: getting them there safely

Match the transport to the risk. A client at acute risk should not drive themselves to the ED. For a client who is safe to travel with support, a family member or trusted person can accompany them; for imminent danger, or a client who cannot be kept safe, 911 is the route, and emergency medical services or law enforcement can transport. The 988 Suicide & Crisis Lifeline can also connect you to mobile crisis options in many areas.

Name the transport plan in the note, including who is responsible for it. The 988 line is reachable by call or text to 988 or by chat and can help coordinate a crisis response short of an ED trip when that is the better fit 67; 911 is for imminent, immediate danger. If a client refuses to go and you cannot keep them safe, a welfare check may be the next step — and how you request one, and what you can disclose in doing so, is its own decision.

Closing the loop: follow-up after the ED visit

The handoff is not finished until the loop closes. After the ED visit, obtain the discharge information, confirm what was recommended, and schedule the post-discharge appointment promptly — the days right after an emergency visit are a high-risk window, which is exactly why timely follow-up after an ED visit for mental illness is a tracked quality measure 8. A client who leaves the ED with no next appointment is the thread breaking.

Reach out to the client and, with consent or under the treatment and safety allowances, to the ED to learn the disposition and any changes to the plan. Document the whole chain — the referral, the handoff, the discharge, and the resumed care — so the record shows continuity rather than a gap. A crisis at a distance makes this harder, because a remote client may be discharged to a facility far from you; plan the follow-up logistics accordingly.

Documenting and billing the crisis work around the handoff

The crisis session that precedes an ED handoff is often itself a billable service. The time-based crisis psychotherapy codes cover the urgent assessment and stabilization of a patient in high distress, and the note must document the total time and the crisis presentation to support them 9. The coordination work — the calls, the written summary, the follow-up — is part of the clinical record even where it is not separately billable.

Keep the billing and the record consistent. If you spent the session assessing acute risk and arranging emergency care, that is a different service from a routine visit, and the note should show the acuity and the minutes. Document the handoff steps themselves too: whom you called, what you sent, how the client traveled, and how you closed the loop. That documentation is what proves the thread never actually dropped.

Common questions

The ED fits acute, immediate risk — imminent danger to self or others, a medical component, or a need for monitoring and evaluation outpatient care cannot provide today. Mobile crisis teams and a strengthened safety plan often match a client who is distressed but not in immediate danger better than an emergency department. Documenting why you chose one over the other is part of the decision.

HIPAA lets you share what the ED needs for treatment and care coordination, and to disclose the minimum necessary to lessen a serious and imminent threat. Send the clinical summary, not your psychotherapy notes, which generally need written authorization. If the client's care falls under 42 CFR Part 2 for a substance use disorder program, rely on its medical-emergency exception and document your basis.

Send both. A phone call gives the ED the urgent picture, but a written summary survives the shift change that happens before the client is seen and lands in the chart. Include the reason for referral, your risk assessment, the safety plan, current medications by name, and your contact information. The safety plan you built should travel with the client so both settings work from one plan.

Promptly — the days immediately after an emergency visit are a high-risk window, which is why follow-up after an ED visit for mental illness is a tracked quality measure. Obtain the discharge information, confirm the recommendations, and schedule the next appointment before the gap widens. A client who leaves the ED with no next appointment is where the thread most often breaks.

If the client refuses and you cannot keep them safe, the options narrow to involving people who can — a family member or support person for a client at moderate risk, or 911 and emergency services for imminent danger. When you cannot locate or reach a client at acute risk, a welfare check may be the next step. Document the refusal, your assessment, and every action you took.

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References

  1. 1.Posner K, Brown GK, Stanley B, et al. (2011). The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry. link ✓That the Columbia-Suicide Severity Rating Scale is a validated structured suicide-severity assessment, used here to distinguish acute risk that warrants an emergency department from chronic risk a safety plan and closer follow-up can hold.
  2. 2.HHS Office for Civil Rights (2026). HIPAA Privacy Rule and Sharing Information Related to Mental Health. U.S. Department of Health and Human Services. linkOCR's mental-health guidance that a provider may share information for treatment and may disclose the minimum necessary to a family member or emergency provider to lessen a serious and imminent threat, used here for what may be disclosed to the ED without separate consent.
  3. 3.HHS Office for Civil Rights (2026). Does HIPAA provide extra protections for mental health information compared with other health information?. U.S. Department of Health and Human Services. linkOCR's FAQ that psychotherapy notes are separately protected and most disclosures require the client's authorization, used here to send the ED a clinical summary rather than the provider's process notes.
  4. 4.U.S. Department of Health and Human Services (2024). Fact Sheet: 42 CFR Part 2 Final Rule. U.S. Department of Health and Human Services. linkHHS's summary of the 2024 Part 2 final rule and its compliance date, used here to note that substance use disorder records under 42 CFR Part 2 carry stricter consent rules, that the rule aligned much of the framework with HIPAA as of February 2026, and that a medical-emergency exception exists.
  5. 5.Stanley B, Brown GK (2012). Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk. Cognitive and Behavioral Practice. linkThe Stanley-Brown safety planning intervention and its six-step structure, used here for why the safety plan should travel with the client to the ED so the receiving team can see and reinforce what is already in place.
  6. 6.Substance Abuse and Mental Health Services Administration (2026). 988 Suicide & Crisis Lifeline. SAMHSA. link ✓That 988 is the national Suicide & Crisis Lifeline administered by SAMHSA, used here as the clinician-facing crisis resource and a route to mobile crisis options short of an ED trip.
  7. 7.988 Suicide & Crisis Lifeline (2026). 988 Lifeline. 988 Suicide & Crisis Lifeline. link ✓The 988 Suicide & Crisis Lifeline's services across call, text, and chat, used here to describe how the line is reached when coordinating a crisis response.
  8. 8.National Committee for Quality Assurance (2026). HEDIS. National Committee for Quality Assurance (NCQA). link ✓That HEDIS includes a follow-up-after-ED-visit-for-mental-illness measure, used here to underscore why timely follow-up after an emergency visit is a recognized high-risk window and part of care continuity.
  9. 9.APA Services, Inc. (2025). Psychotherapy Codes for Psychologists. APA Services, Inc.. link ✓APA Services' guidance on the psychotherapy CPT family, including the time-based crisis codes, used here for how the crisis session preceding a handoff is documented and billed when it is an urgent assessment rather than a routine visit.

https://www.gale.care/for-providers/cs-ed-handoff-workflow · 9 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.

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