METHOD FOR UNDERSTANDING ADMISSION DECISION-MAKING IN A PSYCHIATRIC EMERGENCY ROOM

Objective: To increase understanding of decisions about inpatient admi ssion, a four-step algorithm was used to examine 2,073 consecutive vis its to a public hospital psychiatric emergency room, 684 of which resu lted in admission. Methods: Admission decision outcomes and patient da ta were cross-tabulated to identify conditions, or rules, under which outcome was almost certain. Discriminant function models were then mad e of individual clinicians' decision-making processes and of individua l diagnostic groups. To understand cases not covered in previous steps , a third discriminant function model was constructed. Results: The fo ur-step method successfully predicted outcomes in 85 percent of cases at a minimum of an 80 percent confidence level. The variables of psych osis and violence combined into the most powerful predictor of admissi on. Twelve rules that applied to 41.4 percent of all cases were found. Eleven models of individual clinicians' decision policies applied to slightly more than half of all cases and successfully classified about 95 percent of them. Eleven models of diagnostic groups applied to 93. 2 percent of all cases and correctly predicted about 75 percent. The f inal discriminant model for the 171 cases not covered by the first thr ee steps correctly classified about 90 percent of residual cases. Conc lusions: Psychiatric admission decisions are influenced by multiple va riables that should be studied by examining general admission criteria and differences between clinicians.