Missed Serious Medical Illness in Psychiatric Patients Seen in an Academic Emergency Department

Psychiatric presentations are common in the emergency department (ED), and determining whether or not a psychiatric presentation is due to medical illness can be a difficult task for the emergency physician. The investigators define "serious medical illness" (SMI) as a pathological condition that would necessitate inpatient treatment on a medical or surgical ward. It is important for patient safety that SMI be triaged by the emergency physician to the appropriate inpatient service. The rate of missed SMI in patients with psychiatric presentations to the ED is unknown. The investigators will research missed SMI in patients referred to adult psychiatry from the ED, with the intent to improve patient safety.

Study Overview

• Status: Unknown
• Conditions: Emergency Services, Psychiatric

• Study Type: Observational
• Enrollment (Anticipated): 800

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Adults emergency room patients referred to adult psychiatry by the emergency physician

Description

Inclusion Criteria:

• All patients greater than or equal to 18 years of age presenting to London Health Sciences Centre, Victoria Hospital emergency department between October 1, 2014 - July 31, 2015 who were referred to adult psychiatry by the emergency physician.

Exclusion Criteria:

• None

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of patients admitted to a medical / surgical service within 7 days of psychiatry referral in the emergency department		Approximately 8 months
Medical / surgical admission diagnosis	This will be extracted from the electronic medial record.	Approximately 8 months
Number of days after psychiatric referral that patient is admitted to medical / surgical service		Approximately 8 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of patients discharged home from the emergency department by psychiatry following referral by the emergency physician		Approximately 8 months
Risk factors associated with medical / surgical admission after initial psychiatry referral	The investigators will be extracting variables from the patient's chart including triage vital signs, past medical and psychiatric history, initial laboratory bloodwork, and determining if any of these are risk factors for subsequent medical / surgical admission.	Approximately 8 months
Number of admissions to medical / surgical service within 30 days of discharge from psychiatry		Approximately 8 months

Collaborators and Investigators

• Sponsor: Western University, Canada

Study record dates

Study Major Dates

• Study Start: October 1, 2015
• Primary Completion (Anticipated): December 1, 2015
• Study Completion (Anticipated): December 1, 2015

Study Registration Dates

• First Submitted: August 8, 2015
• First Submitted That Met QC Criteria: October 19, 2015
• First Posted (Estimate): October 20, 2015

Study Record Updates

• Last Update Posted (Estimate): October 20, 2015
• Last Update Submitted That Met QC Criteria: October 19, 2015
• Last Verified: October 1, 2015

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 107073