title: Psychiatric patient disposition agreement between the emergency physician and the psychiatry consultant.
abstract: BACKGROUND
  Mental illness is prevalent, disabling, and costly. Emergency department (ED) visits for mental health-related reasons are on the increase.
  
  
  OBJECTIVE
  Determine the level of agreement between emergency physicians and psychiatrists regarding psychiatric patient disposition.
  
  
  METHODS
  We conducted a prospective, observational study at a private university hospital ED from October 2008-April 2009 using a convenience sample of patients of all ages with psychiatric complaints who received formal psychiatric consultation during their ED visit. The emergency physician completed a data sheet prior to psychiatric consultation, assessing the likelihood of admission for psychiatric evaluation. We evaluated the positive predictive value (PPV) and negative predictive value (NPV) of the emergency physician admission decision for all patients before psychiatric consultation, compared with the patients' actual disposition as determined by the consulting psychiatrist.
  
  
  RESULTS
  The study captured 230 subjects, 53% of whom were suicidal patients. 74% of patients were eventually admitted. The emergency physician decision to admit for inpatient psychiatric evaluation had a PPV of 87.3% (CI 81.4-91.9%) and an NPV of 66.7% (CI 52.9-78.6%) compared to the psychiatrist decision for the total sample, and a PPV of 90% (CI 82.4-95.1%) and an NPV of 69.6% (CI 47.1-86.8%) for suicidal patients. Additionally, the κ score, a measure of agreement between emergency physician disposition decision and psychiatrist disposition decision, was 0.530 (Cl 0.404-0.656). 95% of patients with an ED assessment of "definitely admit" were eventually admitted by the psychiatrist.
  
  
  CONCLUSIONS
  Emergency physician disposition has a high PPV (87.3%) and a moderate NPV (66.7%) compared to psychiatrist disposition.
authors.affiliation: Department of Emergency Medicine, Irvine School of Medicine, University of California, Orange, CA, USA. bchakrav@uci.edu
authors.forename: Bharath
authors.initials: B
authors.lastname: Chakravarthy
authors.forename: Michael
authors.initials: M
authors.lastname: Menchine
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Thompson
authors.forename: Sindhya
authors.initials: S
authors.lastname: Rajeev
authors.forename: Barbara-Jean
authors.initials: BJ
authors.lastname: Santos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004635:Emergency Medicine / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy; D008875:Middle Aged; D011446:Prospective Studies; D011570:Psychiatry / Q000706:statistics & numerical data*; D055815:Young Adult