Medical clearance in the psychiatric emergency setting: a call for more standardization

Literature suggests little standardization in the practice of medical clearance of patients who present to emergency rooms in psychiatric crisis. The present quality improvement study examined current practice in a large psychiatric teaching hospital setting. Using chart review, the completeness of physical examination was examined for 10 body areas in a random sample of 20 psychiatric patients admitted via a psychiatric emergency department (ED) during a one-month period. Charts were examined for four professional groups - family physicians or nurse practitioners, psychiatry residents, medical students and general ED physicians. Results indicated a wide variation in documentation across the four groups and some body systems that were consistently never assessed. To improve standardization, a physical examination form is proposed that is user friendly and based on a review of current literature.