Does Targeted Education of Emergency Physicians Improve Their Comfort Level in Treating Psychiatric Patients?

Abstract

Introduction:We determined if targeted education of emergency physicians (EPs) regarding the treatment of mental illness will improve their comfort level in treating psychiatric patients boarding in the emergency department (ED) awaiting admission.Methods:We performed a pilot study examining whether an educational intervention would change an EP’s comfort level in treating psychiatric boarder patients (PBPs). We identified a set of psychiatric emergencies that typically require admission or treatment beyond the scope of practice of emergency medicine. Diagnoses included major depression, schizophrenia, schizoaffective disorder, bipolar affective disorder, general anxiety disorder, suicidal ideation, and criminal behavior. We designed equivalent surveys to be used before and after an educational intervention. Each survey consisted of 10 scenarios of typical psychiatric patients. EPs were asked to rate their comfort levels in treating the described patients on a visual analogue scale. We calculated summary scores for the non intervention survey group (NINT) and intervention survey group (INT) and compared them using Student’s t-test.Results:Seventy-nine percent (33/42) of eligible participants completed the pre-intervention survey (21 attendings, 12 residents) and comprised the NINT group. Fifty-five percent (23/42) completed the post-intervention survey (16 attendings, 7 residents) comprising the INT group. A comparison of summary scores between ‘NINT’ and ‘INT’ groups showed a highly significant improvement in comfort levels with treating the patients described in the scenarios (P = 0.003). Improvements were noted on separate analysis for faculty (P = 0.039) and for residents (P = 0.012). Results of a sensitivity analysis excluding one highly significant scenario showed decreased, but still important differences between the NINT and INT groups for all participants and for residents, but not for faculty (all: P = 0.05; faculty: P = 0.25; residents: P = 0.03).Conclusion:This pilot study suggests that the comfort level of EPs, when asked to treat PBPs, may be improved with education. We believe our data support further study of this idea and of whether an improved comfort level will translate to a willingness to treat.

Caring for the mental illness patient in emergency departments – an exploration of the issues from a healthcare provider perspective

“…, Zun ) and that this lack of preparation can result in less‐than‐ideal MH patient management in ED (Marciano et al . ).…”

“…An international study of ED physicians found that focused MH education improved their comfort in treating patients with an MI (Marciano et al . ). The variability in preparation, and acknowledged knowledge deficit, reveal a need for regular education and training to prepare emergency staff to care for patients with MI (Department of Human Services ).…”

“…While most experts would agree that educational preparation is important, national and international studies indicate that ED staff are not educationally prepared to care for MH patients (Kerrison & Chapman , Marciano et al . , Tishler et al . , Zun ) and that this lack of preparation can result in less‐than‐ideal MH patient management in ED (Marciano et al .…”

Validity and reliability of a novel Color-Risk Psychiatric Triage in a psychiatric emergency department

“…The resultant data may facilitate the linking of different risk levels of PEP with specific interventions or actions algorithms in EDs [ 41 ]. Thus, structured systems with clear algorithms for identifying and treating PEP could improve the comfort level of emergency room physicians in treating psychiatric patients [ 42 ].…”

Critical Appraisal of Emergency Medicine Education Research: The Best Publications of 2012

“…The sources of funding were as follows: five federal (two NIH, one Canada, and one Taiwan), five universitysponsored, two industry-supported, and two organizationally funded. Research methodology included 17 surveys (36%), 17,19,21,25,30,31,33,37,40,42,46,[50][51][52]54,60,61 15 (31%) observational analyses, [14][15][16]22,23,27,32,33,38,44,47,49,56,57,59 and three (6%) qualitative methodology studies. 19,28,45 There were only 12 (25%) with an experimental or quasi-experimental study design, 20,24,26,35,36,39,41,43,48,53,55,57 with five of the highlighted articles using this rigorous design.…”