The Psychiatric Emergency Research Collaboration-01: methods and results.
OBJECTIVE
To describe the Psychiatric Emergency Research Collaboration (PERC), the methods used to create a structured chart review tool and the results of our multicenter study.


METHODS
Members of the PERC Steering Committee created a structured chart review tool designed to provide a comprehensive picture of the assessment and management of psychiatric emergency patients. Ten primary indicators were chosen based on the Steering Committee's professional experience, the published literature and existing consensus panel guidelines. Eight emergency departments completed data abstraction of 50 randomly selected emergency psychiatric patients, with seven providing data from two independent raters. Inter-rater reliability (Kappas) and descriptive statistics were computed.


RESULTS
Four hundred patient charts were abstracted. Initial concordance between raters was variable, with some sites achieving high agreement and others not. Reconciliation of discordant ratings through re-review of the original source documentation was necessary for four of the sites. Two hundred eighty-five (71%) subjects had some form of laboratory test performed, including 212 (53%) who had urine toxicology screening and 163 (41%) who had blood alcohol levels drawn. Agitation was present in 220 (52%), with 98 (25%) receiving a medication to reduce agitation and 22 (6%) being physically restrained. Self-harm ideation was present in 226 (55%), while other-harm ideation was present in 82 (20%). One hundred seventy-nine (45%) were admitted to an inpatient or observation unit.


CONCLUSIONS
Creating a common standard for documenting, abstracting and reporting on the nature and management of psychiatric emergencies is feasible across a wide range of health care institutions.
Boudreaux
Edwin D
ED
Emergency Medicine and Psychiatry, Cooper University Hospital and UMDNJ-RWJMS, One Cooper Plaza, Camden, NJ 08103, USA. edwin.boudreaux@umassmed.edu
Allen
Michael H
MH
Claassen
Cindy
C
Currier
Glenn W
GW
Bertman
Louise
L
Glick
Rachel
R
Park
Jennifer
J
Feifel
David
D
Camargo
Carlos A
CA
D003299:Cooperative Behavior; D004282:Documentation / Q000592:standards; D004637:Emergency Services, Psychiatric / Q000592:standards*; D006302:Health Services Research / Q000379:methods* / Q000592:standards*; D006769:Hospitals, General; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008609:Mental Status Schedule; D015337:Multicenter Studies as Topic; D011785:Quality Assurance, Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards; D012016:Reference Values; D012017:Referral and Consultation / Q000592:standards; D012189:Retrospective Studies; D012449:Safety / Q000592:standards; D016728:Self-Injurious Behavior / Q000517:prevention & control; D015813:Substance Abuse Detection / Q000592:standards; D014218:Triage / Q000592:standards; D014481:United States