HOW INDIVIDUAL CLINICIAN MAKE ADMISSION DECISIONS IN PSYCHIATRIC EMERGENCY ROOMS

The goal of this study was to understand how individual clinicians mak e admission decisions in the psychiatric emergency room. Clinical and demographic data were collected on 7485 consecutive visits to four psy chiatric hospitals in Israel during 1991 and 1992. This was about one- third of visits to psychiatric emergency rooms in Israel during this t ime. Twenty-one decision makers who made at least 50 decisions and adm itted more than 15 and less than 85% of patients were included. Decisi on to admit patients was modeled using step-wise discriminant analysis . Clinicians examined different numbers of patients and admitted at di fferent rates. In one hospital one group of clinicians appears to rely primarily on diagnosis and another group on other variables, predomin ately previous history, and social or referral factors. The most influ ential background variable was self-referral which favored not admitti ng patient. The most influential diagnoses were schizophrenia and affe ctive disorder which favored admission. In another hospital the most i mportant variables in most models were legal status of admission, numb er of previous hospitalizations, violence and suicide as presenting pr oblems and referral source. All variables except referral source favor ed admission. Some referral sources favored admission and others did n ot. In the last hospital studied the most salient variable was self-re ferral which favored not admitting patient. Decisions in one hospital were not modeled because no clinician mel study inclusion criteria. Th ere appears to be variability between clinicians in what information t hey use to make their decisions in the psychiatric emergency room and what percent of patients they admit.