As electroconvulsive therapy (ECT) requires general anesthesia and is associated with both cognitive and non-cognitive side effects, careful consideration must be given to the safety aspects of providing ECT on an outpatient basis. Drawing upon published literature and their clinical experience administering outpatient ECT, the authors propose best practices for safely providing ECT to outpatients. They review criteria for selecting patients for outpatient ECT as well as treatment and programmatic issues. The authors highlight the importance of educating referring clinicians as well as patients and their families about factors involved in the safe delivery of ECT for outpatients. Fiscal considerations and the drive toward reduced length of stay are prompting insurers and caregivers to choose outpatient over inpatient ECT. For each patient, such a choice merits a careful analysis of the risks of outpatient ECT, as well as the implementation of measures to ensure patient safety. (Journal of Psychiatric Practice 2012;18:130–136)
The Johns Hopkins University and The Johns Hopkins Hospital, Baltimore, MD
The authors thank Dr Laura Fochtmann for helpful suggestions and for reviewing the manuscript.
No financial support was provided for this study. Drs. Reti and Vaidya have received grant support from NIH and HDRF and study supplies at no cost from Neuronetics Inc. Dr Reti is also site PI on a multi-site transcranial magnetic stimulation trial sponsored by Brainsway Inc. The other authors report no disclosures.
Please send correspondence to: Irving Reti, MBBS, Associate Professor, Psychiatry and Neuroscience, Director, Brain Stimulation Program, Johns Hopkins University, 600 N. Wolfe St., Meyer 3-181, Baltimore, MD 21205. firstname.lastname@example.org