Background <p>The number of psychiatric emergencies in central emergency rooms (ER) is rising steadily. In 2024, a&#xa0;total of around 13&#xa0;million outpatient treatment cases were registered in the emergency departments of German hospitals (German Hospital Association 2025). According to estimates, around 5–15% of these cases primarily concern psychiatric or psychosocial treatment. Possible influencing factors include structural deficits in outpatient care, long waiting times for therapy, and changes in utilization patterns. At the same time, emergency departments report an increase in conflict-laden situations in everyday care.</p> Objective <p>How can the care of psychiatric emergency patients in central ER be structured, interdisciplinary, and legally secure, in order to improve patient safety and treatment quality in the long term?</p> Materials and methods <p>An interdisciplinary care concept was developed based on an analysis of current challenges and the legal framework. It is based on the (PR_E-)AUD²IT basic algorithm and is being implemented and tested as the psychiatric shock room algorithm (PR_OB_LE_M) at the AGAPLESION Elisabethenstift in Darmstadt.</p> Results <p>The structured approach in the psychiatric ER enables standardized, interdisciplinary initial care for acutely ill patients. Defined roles, clearly regulated communication processes, and team timeouts promote safety, transparency, and legal compliance in the treatment process.</p> Conclusion <p>The establishment of a&#xa0;standardized psychiatric emergency room concept can contribute to improving treatment quality, employee safety, and patient satisfaction. Prospective further development and evaluation of the model is necessary to verify its long-term practicality.</p>