title: Is medical clearance necessary for pediatric psychiatric patients?
abstract: BACKGROUND
  Although most studies have found low rates of organic illness in patients with isolated psychiatric complaints, psychiatric patients are frequently brought to emergency departments (EDs) for medical clearance.
  
  
  OBJECTIVE
  To assess the utility of ED medical clearance before transfer of pediatric patients on psychiatric holds to inpatient psychiatric facilities, and to evaluate charges associated with ED medical clearance.
  
  
  METHODS
  Retrospective study of pediatric psychiatric patients in one urban pediatric ED with 22,000 annual patient visits over an 18-month period. Patients were included if transported to the ED for medical clearance after being placed on an involuntary psychiatric hold in the prehospital setting. Main outcome measures were charges for screening laboratory tests and secondary ambulance transfers and wages for sitters resulting from ED visits for medical screening examinations of patients on psychiatric holds. We also determined what percentage of patients truly warranted a medical screen and the percentage of psychiatric holds overturned, avoiding transfer to a psychiatric hospital.
  
  
  RESULTS
  There were 789 patients included; 72 (9.1%) were determined to require medical screening. Total charges for laboratory assessments and secondary ambulance transfers and wages for sitters were $1,241,295, or US$17,240 per patient requiring a medical screen. Only 35 (4.4%) holds were overturned in the ED.
  
  
  CONCLUSIONS
  Few patients brought to the ED on an involuntary hold required a medical screen. Use of basic criteria in the prehospital setting to determine who required a medical screen (altered mental status, ingestion, hanging, traumatic injury, unrelated medical complaint, rape) could have led to significant savings.
authors.affiliation: Department of Emergency Medicine, LAC+USC Medical Center, Keck School of Medicine at the University of Southern California, Los Angeles, California.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Santillanes
authors.affiliation: Department of Pediatrics, LAC+USC Medical Center, Los Angeles, California.
authors.forename: Joy Joelle
authors.initials: JJ
authors.lastname: Donofrio
authors.affiliation: Department of Emergency Medicine, LAC+USC Medical Center, Keck School of Medicine at the University of Southern California, Los Angeles, California.
authors.forename: Chun Nok
authors.initials: CN
authors.lastname: Lam
authors.affiliation: Department of Emergency Medicine, LAC+USC Medical Center, Keck School of Medicine at the University of Southern California, Los Angeles, California.
authors.forename: Ilene
authors.initials: I
authors.lastname: Claudius
mesh_terms: D000293:Adolescent; D000552:Ambulances / Q000191:economics; D002648:Child; D019411:Clinical Laboratory Techniques / Q000191:economics; D003955:Diagnostic Tests, Routine; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D017722:Hospital Charges; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis*; D009728:Nursing Assistants / Q000191:economics; D010360:Patient Transfer; D010808:Physical Examination; D012189:Retrospective Studies; D019037:Urban Health Services
keywords: medical clearance; pediatric; psychiatry