Validation of a triage algorithm for psychiatric screening (TAPS) for patients with psychiatric chief complaints

The process of medical clearance screening for patients with psychiatric chief complaints has not been standardized.

To investigate the validity of a triage algorithm for psychiatric screening (TAPS) as a method to screen for the absence of acute medical illness in these patients.

The current study was a structured, retrospective medical record review in a suburban community teaching hospital with 37,000 emergency department visits per year. All ambulatory patients presenting to triage with a psychiatric chief complaint from January 31, 2001, to June 21, 2002, were assessed with TAPS. Patients with a completed TAPS and a negative assessment were identified and included in the study. A negative TAPS assessment comprised age younger than 65 years, normal vital signs, no medical complaints, no evidence of recent substance use, and no history of schizophrenia, mental retardation, or hallucinations. Emergency department records, return visit records, and inpatient admission records were reviewed for the diagnosis or management of acute medical illness.

A total of 1179 patients were assessed with TAPS, of whom 825 (70%) had negative TAPS assessment and were eligible for inclusion. A random sample of 100 patients was selected from this group, with 7 exclusions. Sixty-six (71%) had a history of mental illness and 51 (55%) were admitted. Further, 25 (27%) had laboratory tests ordered, and none of the laboratory results required medical intervention. Twenty-nine patients (31%) received medication, mostly previously prescribed medications or sleep aids. None of the medications were for treating patients with violent or aggressive behavior. The average length of stay was 409 minutes. No patients (95% confidence interval, 0%-3%; P<.05) received a diagnosis of or treatment for acute medical illness.

The TAPS form is potentially an effective tool in screening for the absence of acute medical illness.