title: Evaluation of the initiation of urine drug screens intended for use in transfer patients.
abstract: OBJECTIVE
  The objective of this study was to determine if signs of clinical intoxication were present in patients who had transfer urine drug screens (UDS) performed and to determine the proportion of patients with UDS orders who were actually transferred to another facility.
  
  
  METHODS
  Of all emergency department (ED) patient visits who had a transfer UDS ordered from November 19, 2011, to December 31, 2012, 54% of the population was randomly selected for review by 1 of 3 study investigators. For quality assurance, a random sample of 100 patient charts was independently reviewed by all 3 investigators to assure consistency in interpreting data. Demographics, clinical characteristics and history, disposition, and laboratory results were recorded.
  
  
  RESULTS
  Of the 639 patients included in this study, only 18% were transferred to another psychiatric facility. Pediatric patients and those with presenting with suicidal ideation were more likely to be transferred to an outside facility. Thirty-six percent of the UDS were positive for at least one substance. Marijuana was the most common substance (23%), followed by cocaine (7%) and opiates (7%). There was no evidence that the UDS changed acute management decisions.
  
  
  CONCLUSIONS
  Few (<6%) patients demonstrated any clinical characteristics that were consistent with an acute intoxication. Less than 20% of patients who had a transfer UDS were actually transferred to an outside facility corresponding with more than 80% not ordered appropriately according to the ED established guidelines. This number of inappropriate tests represented more than $152 000 of avoidable UDS cost during the study period.
authors: Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors: Priyanka
authors: P
authors: Vakkalanka
authors: Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors: William F
authors: WF
authors: Rushton
authors: Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors: Lewis S
authors: LS
authors: Hardison
authors: Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
authors: Matthew C
authors: MC
authors: Bishop
authors: Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors: Doris M
authors: DM
authors: Haverstick
authors: Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors: Christopher P
authors: CP
authors: Holstege
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010360:Patient Transfer / Q000379:methods* / Q000706:statistics & numerical data; D015813:Substance Abuse Detection / Q000592:standards / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000652:urine; D055815:Young Adult