Agreement between Emergency Physicians and Psychiatrists Regarding Admission Decisions

Abstract

Objective: To determine the level of agreement between emergency physicians (EPs) and psychiatrists regarding the need for acute psychiatric hospitalization and treatment for patients presenting with alleged psychiatric complaints. Methods: A prospective, cross‐sectional assessment of concordance between EPs and psychiatrists in psychiatric admission decisions was performed at an urban county, teaching hospital ED. The participants had been brought to the ED for psychiatric evaluation. The patients were interviewed by an attending EP or a senior‐level resident, and a tentative impression and disposition were determined pfior to an independent examination and final disposition by a psychiatrist. Strength of physician group agrement was determined using the k statistic. Results: The patient mean age was 37.5 ± 15 years; 51% were men. The most common reasons for evaluation were disruptive behavior (28%), overdose (24%), and danger to self (23%). Of the 156 patients, 47 (28.7%) were sent home without treatment, 10 (6.3%) were determined to need only medical treatment, and 6 (3.7%) were released with outpatient psychiatric treatment. There were 84 (55.7%) patients admitted for psychiatric treatment. The EPs and psychiatrists had only moderate agreement regarding danger to self (k = 0.44), danger to others (k = 0.40). substance abuse as the primary problem (k = 0.50), and need for psychiatric hospitalization (k = 0.54). Conclusion: Moderate agreement between EPs and psychiatrists in key impressions and admission decisions suggests that shared training in psychiatric decision making, especially during residency training, is desired in this setting.

Emergency Medicine and Psychiatry Agreement on Diagnosis and Disposition of Emergency Department Patients With Behavioral Emergencies

“…A higher proportion of patients were admitted for acute psychiatric hospitalization (73%) in our study than in the study by either Garbrick et al (56%) 6 or Tse et al (59%). 7 We found that the most common reasons for admission were placement on involuntary hold and need for acute psychiatric treatment.…”

“…Previous studies assessing agreement between equally weighted physicians' diagnoses also used kappa values to evaluate agreement. 6,10 …”

“…Comparison of the studies' chief diagnoses is difficult because each used different categories of psychiatric illness. Garbrick et al 6 did not report diagnoses, but the most common reasons for presentation were disruptive behavior (28%), overdose (24%), danger to self (23%), selfinflicted trauma (9%), other (9%), domestic violence (3%), and hallucination (3%). The most common diagnoses reported by Tse et al 7 were schizophrenia (41%), depression (15%), and adjustment disorder (10%).…”

“…We were only able to identify two previous studies, both published over 10 years ago, that examined the agreement of EPs with consulting psychiatrists' assessments of ED patients with psychiatric complaints. 6,7 Garbrick et al 6 conducted a study at a California county teaching hospital in 1996, and Tse et al 7 conducted a study in a large acute care facility in Hong Kong in 1999. 6,7 The patient demographics (i.e., age and sex) in both studies were similar to those in this report.…”

“…6,7 Garbrick et al 6 conducted a study at a California county teaching hospital in 1996, and Tse et al 7 conducted a study in a large acute care facility in Hong Kong in 1999. 6,7 The patient demographics (i.e., age and sex) in both studies were similar to those in this report. However, the current study has twice as many patients as these prior two and is the first to address agreement between EPs and consulting psychiatrists regarding the diagnosis and disposition of ED patients in a large, U.S. teaching hospital.…”