The quality of work-life benefits of a free-standing psychiatric ER likely outweigh any putative educational benefits (which I doubt exist, as addressed below).
Having a free-standing psychiatric ER has several benefits. Two stand out in my mind: 1) It will be specifically staffed for the care of patients with psychiatric presentations. This is important because otherwise you will have nurses who do not have specific psychiatric expertise helping to manage your patients. They may page you about the wrong things, they may react differently to situations that a psychiatric nurse would feel more comfortable managing on his own, and they may want to respond with force to a patient with a psychiatric emergency who could be managed without force. For example, overmedication certainly comes to mind as a potential danger. 2) In a freestanding psychiatric ER, the psychiatric staff have sole responsibility for the patient. In a non-psychiatric ER, frequently (depending on the hospital) the ER staff and the psychiatry consult staff may have co-management responsibilities. There is already bad enough communication between the ER and psychiatry as is -- but if you introduce an additional layer of complexity, you can imagine that some patients may fall through the cracks. For example, in the management of a patient who is going through acute alcohol withdrawal, the ER staff may think that psychiatry is taking care of the patient -- and the psychiatry consult team (who is, by and large, not on site) may think that the ER staff is taking care of the patient. 3) In a freestanding psychiatric ER, the psychiatric staff are responsible for disposition (not the medical ER attendings). This is important because otherwise you will have medical ER attendings breathing down your neck about "getting that guy out of my ER" because they may not understand that some types of psychiatric patients take more time to assess, treat, and provide appropriate disposition for. A psychiatric ER may be able to avoid unnecessary utilization of acute inpatient care. For example, it is not difficult to imagine a scenario in which a patient presents with acute suicidal thinking while she is acutely intoxicated with alcohol, but after she "sleeps it off" overnight, she may decide in the morning that she is not suicidal after all and request to be sent home. In a non-psychiatric ER, that sort of plan ("let patient sleep it off overnight") is often an unacceptable disposition.
In terms of your education, it sounds like you are afraid that you will 'miss out' on patients who initially present with non-psychiatric complaints but who are subsequently found to require psychiatric assessment. I doubt you will 'miss out'. First of all, if you are thinking about medical chameleons (eg., the ER staff thinks that a patient is in a state of acute crisis due to pheochromocytoma), trust me the ER staff will probably call a psych consult anyway. Most ERs will have a fairly low threshold for calling psychiatry. Second, if someone gets admitted to the hospital for acute medical care but later is realized to have an underlying psychiatric cause, then they will certainly call the psychiatry consultation service. And since you as a resident will rotate through both services, you will get plenty of calls.
-AT.
