Genevieve Santillanes1, Joy Joelle Donofrio2, Chun Nok Lam1, Ilene Claudius1. 1. Department of Emergency Medicine, LAC+USC Medical Center, Keck School of Medicine at the University of Southern California, Los Angeles, California. 2. Department of Pediatrics, LAC+USC Medical Center, Los Angeles, California.
Abstract
BACKGROUND: Although most studies have found low rates of organic illness in patients with isolated psychiatric complaints, psychiatric patients are frequently brought to emergency departments (EDs) for medical clearance. STUDY OBJECTIVES: To assess the utility of ED medical clearance before transfer of pediatric patients on psychiatric holds to inpatient psychiatric facilities, and to evaluate charges associated with ED medical clearance. METHODS: Retrospective study of pediatric psychiatric patients in one urban pediatric ED with 22,000 annual patient visits over an 18-month period. Patients were included if transported to the ED for medical clearance after being placed on an involuntary psychiatric hold in the prehospital setting. Main outcome measures were charges for screening laboratory tests and secondary ambulance transfers and wages for sitters resulting from ED visits for medical screening examinations of patients on psychiatric holds. We also determined what percentage of patients truly warranted a medical screen and the percentage of psychiatric holds overturned, avoiding transfer to a psychiatric hospital. RESULTS: There were 789 patients included; 72 (9.1%) were determined to require medical screening. Total charges for laboratory assessments and secondary ambulance transfers and wages for sitters were $1,241,295, or US$17,240 per patient requiring a medical screen. Only 35 (4.4%) holds were overturned in the ED. CONCLUSION: Few patients brought to the ED on an involuntary hold required a medical screen. Use of basic criteria in the prehospital setting to determine who required a medical screen (altered mental status, ingestion, hanging, traumatic injury, unrelated medical complaint, rape) could have led to significant savings.
BACKGROUND: Although most studies have found low rates of organic illness in patients with isolated psychiatric complaints, psychiatricpatients are frequently brought to emergency departments (EDs) for medical clearance. STUDY OBJECTIVES: To assess the utility of ED medical clearance before transfer of pediatric patients on psychiatric holds to inpatient psychiatric facilities, and to evaluate charges associated with ED medical clearance. METHODS: Retrospective study of pediatric psychiatricpatients in one urban pediatric ED with 22,000 annual patient visits over an 18-month period. Patients were included if transported to the ED for medical clearance after being placed on an involuntary psychiatric hold in the prehospital setting. Main outcome measures were charges for screening laboratory tests and secondary ambulance transfers and wages for sitters resulting from ED visits for medical screening examinations of patients on psychiatric holds. We also determined what percentage of patients truly warranted a medical screen and the percentage of psychiatric holds overturned, avoiding transfer to a psychiatric hospital. RESULTS: There were 789 patients included; 72 (9.1%) were determined to require medical screening. Total charges for laboratory assessments and secondary ambulance transfers and wages for sitters were $1,241,295, or US$17,240 per patient requiring a medical screen. Only 35 (4.4%) holds were overturned in the ED. CONCLUSION: Few patients brought to the ED on an involuntary hold required a medical screen. Use of basic criteria in the prehospital setting to determine who required a medical screen (altered mental status, ingestion, hanging, traumatic injury, unrelated medical complaint, rape) could have led to significant savings.
Authors: Tony W Thrasher; Martha Rolli; Robert S Redwood; Michael J Peterson; John Schneider; Lisa Maurer; Michael D Repplinger Journal: WMJ Date: 2019-12
Authors: Stephen Freedman; Jennifer Thull-Freedman; Teresa Lightbody; Kassi Prisnie; Bruce Wright; Angela Coulombe; Linda M Anderson; Antonia S Stang; Angelo Mikrogianakis; Lindy VanRiper; Michael Stubbs; Amanda Newton Journal: BMJ Open Qual Date: 2020-12