Value of Mandatory Screening Studies in Emergency Department Patients Cleared for Psychiatric Admission

Abstract

Introduction: Laboratory and radiographic studies are often required by psychiatric services priorto admitting emergency patients who are otherwise deemed medically stable. Such testing mayrepresent an unnecessary expense that prolongs emergency department stays without significantlyimproving care. This study determines the prevalence of such testing and how often it leads tochanges in care.Methods: We prospectively tracked laboratory testing among psychiatric patients presenting tothe emergency departments of two academic tertiary care facilities. For each visit we determinedwhether laboratory or radiographic studies were ordered, and whether the examination wasconducted at the request of the emergency physician as part of a medical screening examinationor requested by the psychiatry service. We then determined if this testing changed patientdisposition.Results: Our study enrolled 598 patients. Of these, emergency physicians ordered testing as a partof medical screening on 155 patients (25.9%). We found the psychiatry service ordered laboratoryor radiographic studies for 191 of 434 patients (44.0%) who emergency physicians determineddid not require ancillary testing for medical clearance. Of these 191 patients, only one (0.5%; 95%Confidence Interval: 0.01% - 2.9%) had an abnormal result that led to a change in disposition. TotalMedicare reimbursement rates for the additional ancillary testing in this study was $37,682.Conclusion: Ancillary testing beyond what is required for medical clearance of psychiatricemergency patients rarely alters care. Policies that require panels of testing prior to psychiatricadmission are costly and appear to be unnecessary.

Keywords

• emergency department
• psychiatry
• emergency medicine