"Medical clearance" of psychiatric patients without medical complaints in the emergency department

This study was conducted to evaluate the benefit of comprehensive "medical clearance" (history, physical examination, vital signs, laboratory, radiogr aphy) in patients presenting to the Emergency Department (ED) with isolated psychiatric complaints, All patients 16 years and older who presented with a psychiatric complaint and required a psychiatric evaluation before disch arge from the ED were included in the study. Data, obtained in a 5-month co nsecutive, retrospective chart review, included patient age, sex, initial c omplaint, past medical and psychiatric history, initial vital sign measurem ent, physical examination findings, laboratory analysis (electrolytes, comp lete blood count, toxicology screen), chest X-ray study results, and final disposition. The number of patients who could have been referred to a psych iatric unit after a history, physical examination, and stable vital signs, without additional laboratory or radiographic studies, was determined. Ther e were 212 patients who met the inclusion criteria, and all their charts we re available for review. Eighty patients (38%) presented with isolated psyc hiatric complaints coupled with a documented past psychiatric history. All received a comprehensive "medical clearance" in the ED followed by a psychi atric consultation. None of the patients had positive screening laboratory or radiographic results. All were either dispositioned home or to the psych iatric ED. The remaining 132 patients (62%) presented to the ED with medica lly based chief complaints or past medical history requiring further evalua tion in the ED before discharge, The initial complaints of these patients c orrelated directly with the need for laboratory and radiographic "medical c learance" in the ED. Patients with a primary psychiatric complaint coupled with a documented past psychiatric history, negative physical findings, and stable vital signs who deny current medical problems may be referred to ps ychiatric services without the use of ancillary testing in the ED. (C) 2000 Elsevier Science Inc.