"Medically cleared": how well are patients with psychiatric presentations examined by emergency physicians?

Significant numbers of patients present to Emergency Departments (ED) with psychiatric complaints, and alternative or concomitant medical diagnoses are commonly present. The literature reveals that physical examinations on these patients in the ED are often incomplete. The purpose of this study was to assess the completeness of examinations for "medical clearance" in our ED. We conducted a retrospective chart review of consecutive adult patients presenting to our ED over 1 year, using patients with a disposition diagnosis of "schizophrenia" as our subject group. The ED physician and nursing records were analyzed for 17 quantitative and qualitative variables, and these were stratified for age. Complete physical examinations were regularly lacking. Complete vital signs (VS) were documented in only 52% of cases, whereas no VS were recorded in 6% of patients. Older patients were more likely to receive full examinations, but this was not universal. Patients with psychiatric presentations should undergo a complete physical examination, including a full set of VS, before disposition from the ED.