The Psychiatric Emergency Research Collaboration-01: methods and results

Boudreaux, Edwin D.; Allen, Michael H.; Claassen, Cindy; Currier, Glenn W.; Bertman, Louise; Glick, Rachel; Park, Jennifer; Feifel, David; Camargo, Carlos A.; On behalf of the PERC,

doi:10.1016/j.genhosppsych.2009.04.009

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Volume 31, Issue 6 , Pages 515-522, November 2009

The Psychiatric Emergency Research Collaboration-01: methods and results

Edwin D. Boudreaux, Ph.D.
- Emergency Medicine and Psychiatry, Cooper University Hospital and UMDNJ-RWJMS, One Cooper Plaza, Camden, NJ 08103, USA
- Corresponding author. Tel.: +1 508 334 3817, +1 856 701 2153 (cell).
Michael H. Allen, M.D.
- Department of Psychiatry, University of Colorado Health Sciences Center, Denver, CO, USA
Cindy Claassen, Ph.D.
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
Glenn W. Currier, M.D., M.P.H.
- Department of Psychiatry and Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
- VISN2 Center of Excellence, Canandaigua VAMC, Canandaigua, NY, USA
Louise Bertman, Ph.D.
- California Pacific Medical Center, San Francisco, CA, USA
Rachel Glick, M.D.
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
Jennifer Park, M.D.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
David Feifel, M.D., Ph.D.
- Department of Psychiatry, University of California, San Diego Medical Center, San Diego, CA, USA
Carlos A. Camargo Jr., M.D., Dr.P.H.
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
On behalf of the PERC

Received 26 February 2009; accepted 28 April 2009. published online 05 June 2009.

Abstract

Objective

To describe the Psychiatric Emergency Research Collaboration (PERC), the methods used to create a structured chart review tool and the results of our multicenter study.

Method

Members of the PERC Steering Committee created a structured chart review tool designed to provide a comprehensive picture of the assessment and management of psychiatric emergency patients. Ten primary indicators were chosen based on the Steering Committee's professional experience, the published literature and existing consensus panel guidelines. Eight emergency departments completed data abstraction of 50 randomly selected emergency psychiatric patients, with seven providing data from two independent raters. Inter-rater reliability (Kappas) and descriptive statistics were computed.

Results

Four hundred patient charts were abstracted. Initial concordance between raters was variable, with some sites achieving high agreement and others not. Reconciliation of discordant ratings through re-review of the original source documentation was necessary for four of the sites. Two hundred eighty-five (71%) subjects had some form of laboratory test performed, including 212 (53%) who had urine toxicology screening and 163 (41%) who had blood alcohol levels drawn. Agitation was present in 220 (52%), with 98 (25%) receiving a medication to reduce agitation and 22 (6%) being physically restrained. Self-harm ideation was present in 226 (55%), while other-harm ideation was present in 82 (20%). One hundred seventy-nine (45%) were admitted to an inpatient or observation unit.

Conclusion

Creating a common standard for documenting, abstracting and reporting on the nature and management of psychiatric emergencies is feasible across a wide range of health care institutions.

Keywords: Psychiatric emergency, Emergency medicine, Psychiatry