The use and impact of pathology tests in emergency department patients with mental health-related complaints: A cross sectional study.
clinical assessment
emergency
mental health
treatment costs
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
25 Oct 2024
25 Oct 2024
Historique:
revised:
09
08
2024
received:
05
12
2023
accepted:
24
09
2024
medline:
25
10
2024
pubmed:
25
10
2024
entrez:
25
10
2024
Statut:
aheadofprint
Résumé
To evaluate the use and impact of pathology tests in patients who present to the ED with mental health-related complaints. The primary objective is to measure the proportion of patients undergoing pathology tests and assess whether these tests trigger a change in management. In this retrospective study, we reviewed all recorded mental health presentations to our regional ED between January and June 2021. Patient characteristics, pathology tests, subsequent change in management, treatment costs and time to Emergency Physician and Psychiatrist were extracted. Descriptive statistics and multivariate analysis were used to explore associations between variables of interest, ED length of stay (LOS) and change in management. Of 37 900 ED visits, 1462 (3.9%) were mental health-related presentations. Pathology tests were conducted in 47.7% of cases, with 3% leading to a change in management. Pathology tests were associated with increased treatment costs (45% increase for blood tests, 17% for urine), and increased ED LOS (48%). Patients with coexisting medical conditions were three times more likely to have a change in management. Pathology tests should be reserved for patients with high-risk features and based on clinical assessment. Strategic use of pathology tests could avoid unnecessary delays and costs, enhancing patient care in mental health-related ED presentations.
Identifiants
pubmed: 39450423
doi: 10.1111/1742-6723.14516
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.
Références
Australian Institute of Health and Welfare. Emergency department care activity. 2022. [Cited 14 May 2024]. Available from URL: https://www.aihw.gov.au/reports‐data/myhospitals/intersection/activity/ed
Australasian College for Emergency Medicine. Emergency department overcrowding position statement S57. 2021. [Cited 10 September 2021]. Available from URL: https://acem.org.au/getmedia/dd609f9a‐9ead‐473d‐9786‐d5518cc58298/S57‐Statement‐on‐ED‐Overcrowding‐Jul‐11‐v02.aspx
Foster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of ad‐verse events affecting patients after discharge from the hospital. Ann. Intern. Med. 2005; 138: 161–167.
Mohsin M, Forero R, Ieraci S, Bauman AE, Young L, Santiano N. A population follow‐up study of patients who left an emergency department without being seen by a medical officer. Emerg. Med. J. 2007; 24: 175–179. https://doi.org/10.1136/emj.2006.038679
Bittencourt RJ, Stevanato AM, Braganca C, Gottems LBD, O'Dwyer G. Interventions in overcrowding of emergency departments: an overview of systematic reviews. Rev. Saude Publica 2020; 54: 66. https://doi.org/10.11606/s1518-8787.2020054002342
MedicineWise N. Choosing Wisely annual report: Reducing low‐value care for a sustainable healthcare system. 2021. Available from URL: https://www.choosingwisely.org.au/assets/CWA2459_CW_2021_Annual_Report.pdf
Scott IA, Duckett SJ. In search of professional consensus in defining and reducing low‐value care. Med. J. Aust. 2015; 203: 179–181. https://doi.org/10.5694/mja14.01664
Payne K, Risi D, O'Hare A, Binks S, Curtis K. Factors that contribute to patient length of stay in the emergency department: a time in motion observational study. Australas. Emerg. Care 2023; 26: 321–325. https://doi.org/10.1016/j.auec.2023.04.002
Medicine ACfE. Waiting Times in the Emergency Department for People with Acute Mental and Behavioural Conditions. Melbourne: ACEM, 2018.
Medicine ACfE. The Long Wait: An Analysis of Mental Health Presentations to Australians Emergency Departments. ACEM: Melbourne, 2018.
Sweeny A, Keijzers G, O'Dwyer J, Stapelberg NC, Crilly J. Patients with mental health conditions in the emergency department: why so long a wait? Emerg. Med. Australas. 2020; 32: 986–995. https://doi.org/10.1111/1742-6723.13543
Srivastava A, Nair R. Utility of investigations, history, and physical examination in ‘medical clearance’ of psychiatric patients: a meta‐analysis. Psychiatr. Serv. 2022; 73: 1140–1152. https://doi.org/10.1176/appi.ps.202000858
American College of Emergency Physicians Clinical Policies Subcommittee on the Adult Psychiatric Patient, Nazarian DJ, Broder JS et al. Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Ann. Emerg. Med. 2017; 69: 480–498. https://doi.org/10.1016/j.annemergmed.2017.01.036
NSW Health. Mental Health for Emergency Departments – A Reference Guide. NSW Ministry of Health: Crows Nest, 2015.
Conigliaro A, Benabbas R, Schnitzer E, Janairo MP, Sinert R. Protocolized laboratory screening for the medical clearance of psychiatric patients in the emergency department: a systematic review. Acad. Emerg. Med. 2018; 25: 566–576. https://doi.org/10.1111/acem.13368
Chennapan K, Mullinax S, Anderson E et al. Medical screening of mental Health patients in the emergency department: a systematic review. J. Emerg. Med. 2018; 55: 799–812. https://doi.org/10.1016/j.jemermed.2018.09.014
Long B, Keim SM, Betz M, Gottlieb M. Do all adult psychiatric patients need routine laboratory evaluation and an electrocardiogram? J. Emerg. Med. 2022; 63: 711–721. https://doi.org/10.1016/j.jemermed.2022.09.038
Janiak BD, Atteberry S. Medical clearance of the psychiatric patient in the emergency department. J. Emerg. Med. 2012; 43: 866–870. https://doi.org/10.1016/j.jemermed.2009.10.026
Parmar P, Goolsby CA, Udompanyanan K, Matesick LD, Burgamy KP, Mower WR. Value of mandatory screening studies in emergency department patients cleared for psychiatric admission. West. J. Emerg. Med. 2012; 13: 388–393. https://doi.org/10.5811/westjem.2012.1.6754
Riccoboni ST, Darracq MA. 216 does the U stand for useless? Urine drug screen and emergency department psychiatric patients. Ann. Emerg. Med. 2016; 68: S84–S85. https://doi.org/10.1016/j.annemergmed.2016.08.230
Thrasher TW, Rolli M, Redwood RS et al. ‘Medical Clearance’ of patients with acute mental Health needs in the emergency department: a literature review and practice recommendations. WMJ 2019; 118: 156–163.
Fiorillo A, de Girolamo G, Simunovic IF et al. The relationship between physical and mental health: an update from the WPA Working Group on Managing Comorbidity of Mental and Physical Health. World Psychiatry 2023; 22: 169–170. https://doi.org/10.1002/wps.21055
Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta‐analysis. JAMA Psychiatry 2015; 72: 334–341. https://doi.org/10.1001/jamapsychiatry.2014.2502
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata‐driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform. 2009; 42: 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Bureau of Health Information. Activity and performance profiles. Available from URL: https://www.bhi.nsw.gov.au/activity‐and‐performance‐profile
Wand T, D'Abrew N, Barnett C, Acret L, White K. Evaluation of a nurse practitioner‐led extended hours mental health liaison nurse service based in the emergency department. Aust. Health Rev. 2015; 39: 1–8. https://doi.org/10.1071/ah14100
NSW Health. Safety Information 002/24 – Updated: Blood Alcohol Level (BAL) Testing in Emergency Departments. NSW Health: Crows Nest, 2024.