Interrater Agreement Among Psychiatrists in Psychiatric Emergency Assessments

Way, Bruce B.; Allen, Michael; Mumpower, Jeryl L.; Stewart, Thomas R.; Banks, Steven M.

doi:10.1176/ajp.155.10.1423

Cited by 67 publications

(47 citation statements)

References 30 publications

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“…First, the DSM diagnostic categories that were used had limited reliability. Indeed, an acceptable level of diagnostic reliability in psychiatric emergency departments has been found only for broad diagnostic categories, such as psychosis, depression, and alcoholism (26,27). Given the importance of diagnostic classifications in emergency settings, further research is needed to develop a reliable and valid diagnostic tool for use in these settings.…”

Section: Discussionmentioning

confidence: 99%

“…Given the limited validity of DSM (25) classification in emergency settings (26,27), diagnostic variables were recoded into more usable categories on the basis of previous research (5,23,28,29). The categories were mental disorders due to a medical condition, psychotic-spectrum disorders, mood disorders, adjustment disorders, neurotic disorders, psychoactive substance use disorders, other conditions that may be a focus of clinical attention, absent or deferred axis I diagnosis, and other diagnoses.…”

Section: Data Collectionmentioning

confidence: 99%

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Effects of Patient and Health-System Characteristics on Community Tenure of Discharged Psychiatric Inpatients

Bruffærts¹,

Sabbé²,

Demyttenaere³

2004

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6 68 85 5 O ver the past two decades, the organization and provision of mental health care have changed dramatically. The deinstitutionalization of mental health services has resulted in shorter stays in psychiatric hospitals and in larger numbers of psychiatric patients living in the community (1). Many communities have too few resources to help these patients (2). The number of psychiatric referrals to hospital emergency departments has increased, partly because of the general lack of linkage between institutional and community services (3). This trend has been observed both in the United States and in Europe (4).Previous research has provided consistent evidence that persons with previous use of psychiatric services are among the most frequent users of psychiatric emergency departments (5-10). Moreover, patients who are readmitted to inpatient psychiatric care are often found to have been recently discharged from a psychiatric hospitalization. In previous studies, 24 percent of 262 patients (11) and 38 percent of 128 patients (12) with a recent hospital discharge were readmitted within three to six months. In a study of state hospital patients in Massachusetts, Fisher and colleagues (13) found a 50 percent readmission rate within four years of discharge among 5,610 patients. Early hospital readmission has been related to the presence of mental illnesses with poor prognoses (13-15), to poor quality of patients' social networks, and to patients' difficulties with hygiene at discharge (16).Early readmissions, however, may also reflect the quality of postdischarge treatment and care. Some unplanned psychiatric referrals could be explained by the unexpected and acute progression of the patient's mental illness, but the rest may result because the mentally ill person has been discharged from the hospital too soon or because follow-up in the community is ineffective.Lower readmission rates have been associated with the existence of follow-up services. For example, McIntosh and Worley (17) implemented telephone follow-up and aftercare groups for patients who were discharged from a psychiatric hospitalization. Fifteen months after the implementation of these services, these authors found a readmission rate of

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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Effects of Patient and Health-System Characteristics on Community Tenure of Discharged Psychiatric Inpatients

Bruffærts¹,

Sabbé²,

Demyttenaere³

2004

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“…The duration of presenting symptoms was calculated and recorded as days. Broad categories for diagnoses were used because of the low validity of diagnoses based on DSM in psychiatric emergency settings (19). In the case of multiple diagnoses, the main diagnosis was used in this study.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital

Mutlu¹,

Kılıçoğlu²,

Güneş³

et al. 2015

EAJEM

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Aim: We aimed to investigate the characteristics of children and adolescents presented to the psychiatric emergency service (PES) of a mental health hospital. Materials and Methods:Medical records of patients under 18 years of age were reviewed for the first psychiatric emergency visit during a 1-year period. Results:The mean age was 15.82 years and 65.8% (n=711) were female. The most presenting symptoms were suicidal ideation (21.0%; most for girls) and homicide/violence toward others (20.7%; most for boys). The mean duration of symptoms was 265.36 days. The most common diagnoses were conduct disorder (16.7%; most for boys) and conversion disorder (15.5%; most for girls). Of the patients, 51.7% never used any mental health services before. The rate of prior use of mental health service was significantly higher in patients presenting with homicide/violence toward others and self-harm and lower in patients presenting with anxiety and somatic symptoms (p<0.05). Of the patients, 292 (27.0%) took no treatment and 271 (25.1%) were admitted to the psychiatric inpatient unit.Conclusion: PES can be used by half of the families as a first-line therapy unit. PES seems to serve an important role in the continuum of pediatric mental health care, particularly for youths with homicide/violence toward others, and to be a point of access to mental healthcare, particularly for youths with anxiety and somatic symptoms. (Eurasian J Emerg Med 2015; 14: 123-30)

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“…However, psychiatrists' assessments and disposition decisions are not an acceptable criterion standard, since previous studies have demonstrated that agreement among psychiatrists regarding assessment of patients in the ED is often poor. 12 This lack of a criterion standard suggests the need for additional studies with patient outcome data to assess the accuracy of these assessments.…”

Section: Limitationsmentioning

confidence: 99%

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

Douglass¹,

Luo²,

Baraff³

2011

Academic Emergency Medicine

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Objectives: The objective was to determine the level of agreement between emergency physicians (EPs) and consulting psychiatrists in their diagnosis and disposition of emergency department (ED) patients with behavioral emergencies. Methods:The authors conducted a prospective study at a university teaching hospital ED with an annual census of approximately 45,000 patients. During study hours, each time a psychiatric consultation was requested, the emergency medicine (EM) and consulting psychiatry residents were asked to fill out similar short questionnaires concerning their diagnoses and disposition decisions after they consulted with their attending physicians. EM and psychiatry residents were blinded to the other's assessment of the patient. Residents were asked about their evaluation of patients regarding: 1) psychiatric assessments, 2) if the patients presented a danger to themselves or others or were gravely disabled, and 3) the need for emergency psychiatric hospitalization.Results: A total of 408 resident physician pairs were enrolled in the study. Patients ranged in age from 5 to 92 years, with a median age of 31 years; 50% were female. The most common psychiatric assessments, as evaluated by either EPs, consulting psychiatrists, or both, were mood disorder (66%), suicidality (57%), drug ⁄ alcohol abuse (26%), and psychosis (25%). Seventy-three percent were admitted for acute psychiatric hospitalization. Agreement between EPs and psychiatrists was 67% for presence of mood disorder, 82% for suicidality, 82% for drug ⁄ alcohol abuse, 85% for psychosis, and 85% for grave disability. There was 67% agreement regarding patient eligibility for involuntary psychiatric hold. EPs felt confident enough to make disposition decisions 87% of the time; for these patients there was 76% agreement with consulting psychiatrists about the final disposition decision. Conclusions:The 67% agreement between EPs and consulting psychiatrists regarding need for involuntary hold, and 76% agreement regarding final disposition, demonstrate a substantial disagreement between EPs and psychiatrists regarding management and disposition of ED patients with psychiatric complaints. Further studies with patient follow-up are needed to determine the accuracy of the ED assessments by both EPs and consulting psychiatrists.

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Interrater Agreement Among Psychiatrists in Psychiatric Emergency Assessments

Abstract: Psychiatric emergency service assessments need improvement. This may be accomplished by exploring the underlying structure of psychiatric emergency service concepts, the creation and validation of structured assessment tools, and the creation of practice guidelines.

Cited by 67 publications

References 30 publications

Effects of Patient and Health-System Characteristics on Community Tenure of Discharged Psychiatric Inpatients

Effects of Patient and Health-System Characteristics on Community Tenure of Discharged Psychiatric Inpatients

Characteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital

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

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