Emergency physician practices and requirements regarding the medical screening examination of psychiatric patients.
OBJECTIVE
To describe the testing requirements and practices of emergency physicians (EPs) when conducting a medical screening examination of psychiatric patients.


METHODS
An anonymous survey was developed and mailed to 500 EPs randomly selected through American College of Emergency Physicians membership rolls.


RESULTS
Two hundred ninety surveys were returned (58%). Eighty-five percent of the respondents were male, 70% practiced in a community setting and 28% in an academic setting, 58% were emergency medicine (EM) residency-trained, and 88% were EM board-certified or board-eligible. Ninety-eight percent stated they were actively involved with the psychiatric medical screening exam (PMSE). Routine testing was required by 35% of the respondents, with 16% being required by ED protocol, and 84% by the psychiatrist/psychiatric institute. Of those with required testing, tests required were: complete blood cell count (56%), electrolytes (56%), serum alcohol (85%), serum toxicology screen (31%), urine toxicology screen (86%), electrocardiogram (18%), liver function test (16%), blood urea nitrogen (45%), and creatinine (40%). Many clinicians believed that certain tests were unnecessary as part of a PMSE. There was no statistical difference between the opinions of the physicians required to test and those not required to test in terms of which tests they thought were a necessary part of a PMSE regardless of the patient's clinical presentation. The EM-trained physicians were also found to be significantly less likely to think certain tests were necessary for the PMSE when compared with the non-EM-trained physicians.


CONCLUSIONS
Routine testing was required as part of the medical screening examination of psychiatric patients for only one-third of the respondents. Few respondents believed that any of these tests were necessary. Emergency medicine-trained physicians were less likely to feel that routine testing was necessary.
Broderick
Kerry B
KB
Emergency Department, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, CO 80204, USA. kbroderi@dhha.org
Lerner
E Brooke
EB
McCourt
John D
JD
Fraser
Emily
E
Salerno
Killian
K
D000328:Adult; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003625:Data Collection; D003955:Diagnostic Tests, Routine; D004635:Emergency Medicine / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010808:Physical Examination; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011336:Probability; D011795:Surveys and Questionnaires; D014481:United States