Abstract
EPs frequently transfer psychiatric patients to psychiatric hospitals with the approval
and acceptance of a psychiatrist. EPs and psychiatrists have an unknown set of testing
routines and requirements that are used to determine medical clearance of the psychiatric
patient. The purpose of this study was to compare the routine and required testing
performed by EPs as compared with psychiatrists. A survey of routine and required
test ordering for the medical clearance of patients presenting with psychiatric complaints
by EPs and psychiatrists was developed. The survey contained information on the physician
and hospital demographics, tests routinely performed, required tests, and estimated
cost of testing. The survey was distributed to all of the 1,055 EPs in Illinois using
the American College of Emergency Physicians database and all of the 117 psychiatrists
at state-operated psychiatric facilities in the state of Illinois. The surveys were
mailed and remailed to the nonresponders in both groups. The results were inputted
into an SPSS (Chicago, IL) program to determine frequencies, descriptives, and correlations.
The study results comparing the EPs with the psychiatrists were performed using Fisher
exact testing. The survey was returned by 507 (48.1%) of the EPs and 65 (56.4%) of
the psychiatrists. A total of 37.0% of EPs responded who were mostly 31 to 40 years
old (187 of 506), male (347 of 469), and board-certified (348 of 477). The psychiatrists
were mostly 51 to 60 years old (36 of 56), male (34 of 57), and board-certified (42
of 59). The most frequent routine and required tests ordered by EPs and psychiatrists
were a urine drug screen (routine 378 of 507, 45 of 66 and required 381 of 507, 31
of 66), alcohol (348 of 507, 33 of 66 and 348 of 507, 33 of 66), and complete blood
count (270 of 507, 53 of 66 and 334 of 507, 34 of 66) and least frequently electroencephalogram
(0 of 507, 2 of 66 and 1 of 507, 0 of 66), computed tomography scan (6 of 507, 3 of
66 and 2 of 507, 0 of 66), and lumbar puncture (1 of 507, 2 of 66 and 0 of 507, 0
of 66) respectively, at a most frequent estimated cost of required testing of $101
to $200 for EPs (102 of 507) and $201 to $300 for psychiatrists (13 of 66). There
were 10 of 16 differences in routine test ordering and three of 16 required tests
performed by EPs compared with psychiatrists. Although the number of sets required
by both groups were different, the tests required by psychiatrists and EPs for medical
clearance of the psychiatric patients were found to be similar. It is unknown if the
psychiatrists influenced the ordering behavior of the EPs. However, this study does
demonstrate a difference in the routine test ordering, implying that these is a difference
in the approach to the patient in the ED. Further means to obtain congruence in the
testing protocol of psychiatric patients would be a valuable endeavor.
Keywords
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Article Info
Publication History
Accepted:
April 23,
2003
Received:
February 23,
2003
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
