Original contribution
Comparison of EPs’ and psychiatrists’ laboratory assessment of psychiatric patients

https://doi.org/10.1016/j.ajem.2004.02.008Get rights and content

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.

Section snippets

Methods

A survey was developed to ascertain the testing that was routinely performed or required by EPs and a similar one for the psychiatrists. The two almost identical surveys contained information on the physician demographics, including age range, race, gender, hospital information (including transfers, beds, and volume), tests routinely ordered or required (including laboratories, radiographs, electro cardiogram, electroencephalogram), and estimated cost of testing. All of the Illinois EPs and all

Emergency physicians

The survey was returned by 507 of 1,055 (48.1%) of the EPs and 66 of 117 (56.4%) of the psychiatrists. A total of 37% of EPs responded who were mostly 31 to 40 years old (189 of 507), male (347 of 489), and board-certified (348 of 477) (Table 1). Similar numbers worked in an urban setting (48.1%) and suburban setting (46.9%) that was a teaching hospital (27.6%) with mean operating beds of 159 and mean ED volume of 46,701. Three hundred thirty-five of 505 (66.3%) have a psychiatric unit at

Discussion

Although the study did uphold the hypothesis that the EPs and psychiatrists have a different set of routine tests, the hypothesis was not upheld for required testing. The reason for this discrepancy is uncertain. It is thought that EPs order tests that will ensure that the psychiatric patients will be accepted at a psychiatric facility. The evidence in this study that backs up this contention is the number of EPs who do not order any tests and the number that order fewer tests compared with

Conclusion

EPs tend to order a different set of routine tests but a similar set of required tests for the medical evaluation of the psychiatric patient in the ED. These results indicate that there is concurrence in the testing that should be done on psychiatric patients. Whether the EPs changed their practice pattern to accommodate the psychiatrists or agreed with the need to order the set of tests is unknown.

Acknowledgements

The authors acknowledge the efforts of the Illinois Department of Mental Health Medical Clearance Work Group.

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