Information for Referring Providers

We welcome the opportunity to assist in the care of your patient’s psychiatric needs. To learn more about our referral process, please review Electroconvulsive Therapy Information for Referring Providers below.

We request that all providers who are referring patients to our service be available for initial discussion with our ECT provider as well as be able to maintain ongoing contact during the treatment series. We can provide assistance and recommendations surrounding the ECT treatment and pharmacotherapy recommendations, however it is expected that all referring providers will continue to monitor their patients individually during the treatment course. We will work to maintain open communication with each provider, both for updates as well as any question or concerns that may arise during treatments.

Though we accept initial referrals from and will collaborate with mid-level providers during an index course of ECT, a patient with maintenance ECT requirements is a unique, treatment-refractory case that a psychiatrist must follow. If a patient is determined to require maintenance ECT, the outpatient provider must be a psychiatrist. 

Electroconvulsive Therapy Information for Referring Providers – Towson AND Baltimore/Washington Campuses

1. Initial Referral packet to be emailed to CentralRegistration@sheppardpratt.org or faxed to 410-938-3448
   • Outpatient ECT Referral and Order Form - completed via DocuSign
   • Patient contact information - phone number and email address
   • Most recent Progress Note detailing discussion and patient/family agreement to initiate ECT
   • Full list of all prescribed medications (current as well as previously known trials)
   • Patient Insurance information – please send a copy of front & back of insurance card (if available)
2. Lab work– We recommend holding this lab draw until patient is ready to be seen for their intake. Each patient will need the following:
   • CBC, CMP, TSH, FT4 – completed within 30 days of SP Medical Clearance
   • Vitamin D – completed within 6 months of SP Medical Clearance
   • A1C – Required for all patients with Diabetes or if Fasting Glucose is over 100
   • Pregnancy test – for women of childbearing age; must be within 2 weeks of 1st ECT treatment
   • ALL LABS MUST BE RECEIVED BEFORE A SHEPPARD PRATT MEDICAL CLEARANCE IS SCHEDULED
3. EKG: will be completed on day of Sheppard Pratt medical clearance - all ages will have baseline completed
4. Imaging (please discuss with team prior to ordering as need is on a case-by-case basis):
   • CT Head – if history of brain injury
   • Spine imaging – if history of back injury or ongoing symptoms are present
   • Chest X-ray/imaging
5. Other workups:
   • If patient has other significant medical co-morbidities, we may request further clearance by a specialist before initiating treatments. 
6. Medications:
   • We will review all medications prior to initiating treatments. There may be times where we will ask for certain medications to be either discontinued or temporarily held prior to or during treatments. This will be discussed on a case-by-case basis. 
   • Common Medications and Holding Instructions:
     • Lithium: may be given 24 hours before treatment and can resume after treatment.
     • Benzodiazepines: either discontinue (preferred) or switch to shorter acting formulation (i.e., lorazepam or alprazolam). HOLD at least 12 hours before treatment.
     • Metformin/Glucophage: may be given 24 hours before treatment and can resume after treatment.
     • Antiepileptic agents for PSYCHIATRIC indications only: HOLD evening before and morning of treatment. If for SEIZURE disorder, will need further discussion with ECT provider. 
     • Coumadin: INR must be <2.4
7. All patients undergoing ECT should be evaluated by their referring psychiatrist/psychiatric NP/PA within two weeks of starting treatments and then on a regular basis to assess their response to this treatment series. 
8. If a patient is attending a Sheppard Pratt Day Hospital, the psychiatrist in the program will be responsible for monitoring progress and ordering treatments. 
9. Should a patient be determined to need maintenance ECT after the index course is completed, please contact the ECT department for further assistance. 
   •  A discussion with one of our ECT providers is always available if further discussion/questions occur.
   •  An Outpatient ECT Renewal Form will need to be completed by the outpatient psychiatrist. The ECT service will complete the recommendations based on interview of patient and after direct discussion with the outpatient psychiatrist. 

Other Important Items to Consider When Referring for ECT

1. All patients must have at least one designated individual to bring them back and forth for each treatment. Patients are not allowed to drive themselves or use public transport (unless with companion) after an ECT treatment for safety. 
2. Certain medical comorbidities may preclude a patient from receiving ECT in our outpatient-based suite. 
   • BMI of 45 or greater
   • Pregnancy (any trimester)
   • If you have questions, please contact us directly to discuss at 410-938-3485.
3. Each patient will have an intake evaluation by one of our ECT providers. During this interview, the following will occur:
   • The patient will be evaluated for appropriateness as well as expected benefit from ECT. If appropriate, alternative treatments can also be discussed at that time.
   • The patient will be provided with an educational overview of what to expect during the treatment series.
   • The patient will be given the opportunity to ask any questions they may have about the procedure with the ECT expert.
   • ECT risks and benefits will be discussed at this meeting. The consent process for ECT occurs prior to an individual’s first ECT treatment.
4. Once approved for ECT, each patient will have a medical evaluation to clear them for anesthesia with a Sheppard Pratt internist.
   • To be cleared for ECT, all patients require basic lab work that is completed within a specified time frame. 
     • CBC, CMP, TSH/FT4, pregnancy test, Vitamin D, A1C (see checklist)
   • Should acute/concerning history be identified at that time, we may request further specialist evaluations or collateral information. 
   • If you know your patient has a complex medical history, the sooner our team has this information, the faster we can work to identify any further testing/requirements that may be needed to ensure your patient is medically stable to complete this treatment series. 

ECT for Minors

1. At this time, we can offer ECT for minors. However, we require a team of Child/Adolescent providers to assess the appropriateness of treatment before it is initiated. Thus, if a patient is a minor, they must first be admitted to one of our inpatient units for evaluation before ECT would be initiated. 
2. For minors who need continued “maintenance” treatment, please contact the department at 410-938-5100.