Clinical policy: Critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department
From the American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency DepartmentAnnals of emergency medicine (Impact Factor: 4.33). 02/2006; 47(1):79-99. DOI: 10.1016/j.annemergmed.2005.10.002
The western journal of emergency medicine 05/2014; 15(3):312-7. DOI:10.5811/westjem.2013.8.18378
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ABSTRACT: The incidence of respiratory depression in patients who are chemically sedated in the emergency department (ED) is not well understood. As the drugs used for chemical restraint are respiratory depressants, improving respiratory monitoring practice in the ED may be warranted. The objective of this study is to describe the incidence of respiratory depression in patients chemically sedated for violent behavior and psychomotor agitation in the ED.The western journal of emergency medicine 07/2014; 15(4):430-7. DOI:10.5811/westjem.2014.2.19102
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ABSTRACT: Objective The objective of this study was to determine if signs of clinical intoxication were present in patients who had transfer urine drug screens (UDS) performed and to determine the proportion of patients with UDS orders that were actually transferred to another facility. Methods Of all emergency department patient visits that had a transfer UDS ordered from November 19, 2011 to December 31, 2012, 54% of the population was randomly selected for review by one of three study investigators. For quality assurance, a random sample of 100 patient charts was independently reviewed by all three investigators to assure consistency in interpreting data. Demographics, clinical characteristics and history, disposition, and laboratory results were recorded. Results Of the 639 patients included in this study, only 18% were transferred to another psychiatric facility. Pediatric patients and those with presenting with suicidal ideation were more likely to be transferred to an outside facility. Thirty-six percent of the UDS were positive for at least one substance. Marijuana was the most common substance (23%), followed by cocaine (7%) and opiates (7%). There was no evidence that the UDS changed acute management decisions. Conclusions Few (< 6%) patients demonstrated any clinical characteristics that were consistent with an acute intoxication. Less than 20% of patients who had a transfer UDS were actually transferred to an outside facility corresponding with more than 80% not ordered appropriately according to the ED established guidelines. This number of inappropriate tests represented over $152,000 of avoidable UDS cost during the study period.American Journal of Emergency Medicine 09/2014; 32(9). DOI:10.1016/j.ajem.2014.06.011 · 1.15 Impact Factor
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