Psychiatric screening in the emergency department: its effect on physician behavior

The purpose of our prospective, controlled study was to determine whether providing the results of a psychiatric screening instrument, the General Health Questionnaire (GHQ), to emergency physicians would result in a change in the detection and management of patients with psychosocial problems. Five hundred ninety-nine emergency department patients were enrolled, 242 in the control and 357 in the intervention group. Noncritical patients, selected by presenting complaint, were given the GHQ to complete before physician evaluation; those whose GHQ scores were high (10 or higher) were identified as having a greater likelihood of having psychosocial problems. During the intervention phase, physicians were provided the patient's GHQ score before beginning their evaluation, as well as a specific mechanism for psychosocial referral. A significantly greater proportion of patients with high GHQ scores in both study groups were judged by physicians to have a psychiatric problem (P less than .0001). During the intervention phase, patients with high scores more frequently were assigned a psychiatric diagnosis (14.1% vs 7.7%) and received psychosocial referral (36.1% vs 5.7%). However, only the latter difference was statistically significant (P less than .0001). The majority (85.7%) of patients offered psychosocial referral accepted their referral. There was no difference in the number of laboratory tests ordered or medical/surgical referrals requested between patients in the control or intervention groups with high scores. Therefore, providing GHQ results to emergency physicians led to more frequent psychiatric diagnoses and psychosocial referrals of patients with high GHQ scores but did not alter their medical management.