Cs. Korn et al., "Medical clearance" of psychiatric patients without medical complaints in the emergency department, J EMERG MED, 18(2), 2000, pp. 173-176
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.