Sp. Segal et al., FACTORS IN THE QUALITY OF PATIENT EVALUATIONS IN GENERAL-HOSPITAL PSYCHIATRIC EMERGENCY SERVICES, Psychiatric services, 46(11), 1995, pp. 1144-1148
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.