Emergency medicine and psychiatry agreement on diagnosis and disposition of emergency department patients with behavioral emergencies
Academic Emergency Medicine, 04/25/2011
Clinical Article
Douglass AM et al. – The 67% agreement between EPs and consulting psychiatrists regarding need for involuntary hold, and 76% agreement regarding final disposition, demonstrate a substantial disagreement between EPs and psychiatrists regarding management and disposition of ED patients with psychiatric complaints. Further studies with patient follow-up are needed to determine the accuracy of the ED assessments by both EPs and consulting psychiatrists.
Methods- Prospective study
- University teaching hospital ED with annual census of approximately 45,000 patients
- During study hours, each time psychiatric consultation was requested, emergency medicine (EM) and consulting psychiatry residents asked to fill out similar short questionnaires concerning their diagnoses and disposition decisions after they consulted with their attending physicians
- EM and psychiatry residents blinded to other’s assessment of patient
- Residents asked about evaluation of patients regarding: 1) psychiatric assessments, 2) if patients presented danger to themselves or others or were gravely disabled, and 3) need for emergency psychiatric hospitalization
- 408 resident physician pairs enrolled
- Patients ranged in age from 5 to 92 years, with median age of 31 years; 50% female
- Most common psychiatric assessments, as evaluated by either EPs, consulting psychiatrists, or both, were mood disorder (66%), suicidality (57%), drug/alcohol abuse (26%), and psychosis (25%)
- 73% admitted for acute psychiatric hospitalization
- Agreement between EPs and psychiatrists 67% for presence of mood disorder, 82% for suicidality, 82% for drug/alcohol abuse, 85% for psychosis, and 85% for grave disability
- 67% agreement regarding patient eligibility for involuntary psychiatric hold
- EPs felt confident enough to make disposition decisions 87% of time; for these patients 76% agreement with consulting psychiatrists about final disposition decision
