ABSTRACT
This chapter describes the administrative structure and day-to-day operation of a particular psychiatric emergency service. It uses some vignettes to illustrate some of the dilemmas facing the clinician-administrator of such a service. The emergency service described in the chapter is located at Cambridge Hospital, a municipal hospital located in Cambridge, Massachusetts. The assistant clinical director of the psychiatric emergency service is a staff psychiatrist who provides eight hours of clinical backup and functions as a senior teacher with responsibility for coordinating this service's weekly teaching conference. A daily log is kept on all patients who have been seen by psychiatric emergency service staff. During the course of treating the numbers of patients using this service, important administrative issues have arisen which had clinical consequences or implications without easy solutions. The chapter illustrates these issues with a number of vignettes. The vignettes are composites constructed from real experiences to exemplify the administrative issues more clearly.
