FACTORS IN THE QUALITY OF PATIENT EVALUATIONS IN GENERAL-HOSPITAL PSYCHIATRIC EMERGENCY SERVICES

Objective: The study examined the usefulness of a three-perspective mo del for determining the quality of evaluations in psychiatric emergenc y services. The model was used to evaluate the hypothesis that the pro vision of high-quality care in emergency services is primarily influen ced by service objectives related to patients' clinical characteristic s rather than by institutional constraints, such as workload or physic al facilities, or by social biases, such as clinicians' attitudes towa rd patients or perceptions of community expectations. Methods: The eva luations of 683 persons assessed in nine California public facilities were independently observed. Multivariate techniques were used to test the relative importance of patients' clinical characteristics, possib le sources of social bias among clinicians, and institutional constrai nts in influencing three quality-of-care dimensions: technical quality , the art of patient care, and optimum investment of time. Results: Th e findings generally confirmed the hypothesis that patients' clinical characteristics have more influence on the quality of care provided th an institutional constraints or social biases. However, one institutio nal constraint-increased workload demands-led to reduced technical qua lity and to less than optimal use of time. Further, social biases refl ected in the clinicians' like for and preconceptions about the patient also influenced the quality of their evaluations. Conclusions: The mo del is a useful tool for examining quality of care in the psychiatric emergency service. Increasing workload pressures negatively affect qua lity of care.