title: Improving the diagnosis of physical illness in patients with mental illness who present in emergency departments: consensus study.
abstract: OBJECTIVE
  The aim of this study was to establish consensus among clinicians in order to produce recommendations to optimise the diagnosis of physical illness in patients with mental illness who present in Emergency Departments (EDs).
  
  
  METHODS
  A list of recommendations was derived from qualitative interviews conducted with 39 doctors and nurses working in EDs in four general hospitals in England. Using a modified nominal group technique, we then asked a selected group of 15 doctors and nurses to take part in a group discussion with two voting rounds in order to decide which recommendations are most beneficial and feasible.
  
  
  RESULTS
  Five recommendations met the a priori criteria to be considered 'strongly supported'. These included: having a psychiatric liaison team staff available 24 hours a day in the vicinity of the ED; developing detailed guidelines regarding intoxicated patients and regarding parallel assessment of patients by both ED and psychiatric staff; and having regular meetings between representatives of both departments.
  
  
  CONCLUSIONS
  In addition to suggesting specific recommendations, the study stresses the advantages in increasing the accessibility of psychiatric staff in the ED but also identifies challenges regarding joint work and division of responsibilities between them and the ED acute team.
authors: Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park London SE5 8AF, UK. Electronic address: guy.shefer@cantab.net.
authors: Guy
authors: G
authors: Shefer
authors: SLaM, St Thomas Hospital, London, UK; SLaM, King's College Hospital, Denmark Hill London SE5 9RS, UK.
authors: Sean
authors: S
authors: Cross
authors: Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park London SE5 8AF, UK.
authors: Louise M
authors: LM
authors: Howard
authors: Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park London SE5 8AF, UK.
authors: Joanna
authors: J
authors: Murray
authors: Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park London SE5 8AF, UK.
authors: Graham
authors: G
authors: Thornicroft
authors: Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park London SE5 8AF, UK.
authors: Claire
authors: C
authors: Henderson
mesh_terms: D000328:Adult; D015897:Comorbidity; D032921:Consensus; D004636:Emergency Service, Hospital; D004739:England; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D011570:Psychiatry; D012017:Referral and Consultation
keywords: Consensus; Diagnostic overshadowing; Emergency medicine; Mental-health; Modified nominal group technique; RAND Appropriateness method