Feasibility and effects of a Web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department.
OBJECTIVE
To determine the adoption rate of the Web-based Behavioral Health Screening-Emergency Department (BHS-ED) system during routine clinical practice in a pediatric ED, and to assess this system's effect on identification and assessment of psychiatric problems.


METHODS
Descriptive design to evaluate the feasibility of a clinical innovation.


METHODS
The ED of an urban tertiary care children's hospital.


METHODS
Adolescents from 14 to 18 years of age, without acute or critical injuries or illness, presenting with nonpsychiatric symptoms.


METHODS
The ED clinical staff initiated the use of the BHS-ED system, which identifies and assesses adolescents for depression, suicidal ideation, posttraumatic stress, substance use, and exposure to violence. Treating clinicians reviewed results and followed routine care practices thereafter.


METHODS
Adoption rate of the BHS-ED system by nursing staff, identification rates of occult psychiatric problems, and social worker or psychiatrist assessment. Data were collected for 19 months before implementation of the BHS-ED system and for 9 months during implementation.


RESULTS
Of 3979 eligible patients, 1327 (33.4%) were asked by clinical staff to get screened using the BHS-ED; of these 1327 patients, 857 (64.6%) completed the screening and 470 (35.4%) refused. During implementation, identification of adolescents with psychiatric problems increased significantly (4.2% vs 2.5%; odds ratio [OR], 1.70; 95% confidence interval [CI], 1.38-2.10), as did ED assessments by a social worker or psychiatrist (2.5% vs 1.7%; OR, 1.47; 95% CI, 1.13-1.90). Of the 857 patients who were screened with the BHS-ED, 90 (10.5%) were identified as having psychiatric problems (OR, 4.58; 95% CI, 3.53-5.94), and 71 (8.3%) were assessed (OR, 5.12; 95% CI, 3.80-6.88).


CONCLUSIONS
In a busy pediatric ED, computerized, self-administered adolescent behavioral health screening can be incorporated into routine clinical practice. This can lead to small but significant increases in the identification of unrecognized psychiatric problems.
Division of Emergency Medicine, The Children's Hospital of Philadelphia, 3501 Philadelphia, PA 19104, USA. fein@email.chop.edu
Joel A
JA
Fein
Megan E
ME
Pailler
Frances K
FK
Barg
Matthew B
MB
Wintersteen
Katie
K
Hayes
Allen Y
AY
Tien
Guy S
GS
Diamond
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D004637:Emergency Services, Psychiatric / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008403:Mass Screening / Q000379:methods*; D001523:Mental Disorders / Q000175:diagnosis*; D011569:Psychiatric Status Rating Scales