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Variations in Medical Clearance Testing for Mental Health Emergency Department Visits
Chris A Rees1, Matt Hall2, Sriram Ramgopal3
1Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
Insights
Routine medical clearance testing for pediatric mental health emergencies is common, varying widely by hospital and incurring significant costs. These practices may be unnecessary, impacting healthcare spending.
Area of Science:
- Pediatric Emergency Medicine
- Child and Adolescent Psychiatry
- Health Services Research
Background:
- Recommendations advise against routine medical clearance testing for children in emergency departments (EDs) presenting with mental health concerns.
- However, the actual practices, influencing factors, and associated costs remain incompletely understood.
Purpose of the Study:
- To investigate the variation, patient and hospital factors, and costs related to medical clearance testing in pediatric ED encounters for mental health concerns.
Main Methods:
- A cross-sectional study analyzed ED encounters for children aged 5-18 years across 35 US children's hospitals from 2016-2023.
- Medical clearance testing was defined by the performance of specific laboratory and diagnostic tests.
- Generalized estimating equations identified factors associated with testing, and costs were estimated from billed charges.
Main Results:
- Over half (56.9%) of the 604,869 analyzed ED encounters included at least one medical clearance test.
- Significant hospital-level variation in testing prevalence was observed (33.5% to 85.3%).
- Testing was more likely for patients admitted to psychiatric units or transferred to psychiatric facilities, with total annual costs reaching $25,187,999.
Conclusions:
- Medical clearance testing is frequently performed in pediatric ED mental health encounters, despite existing recommendations against it.
- Practices vary considerably across hospitals, suggesting a lack of standardized care.
- These tests represent a substantial financial burden, potentially indicating unnecessary healthcare expenditure.
Background And Objectives:
There are recommendations against routine medical clearance testing for children evaluated in the emergency department (ED) for mental health concerns. Our objective was to determine variation, factors, and costs associated with medical clearance testing during ED encounters for mental health concerns.
Methods:
We conducted a cross-sectional study of ED encounters among children aged 5 to 18 years who presented to 35 US children's hospitals for mental health concerns (2016-2023). We determined the prevalence of medical clearance testing defined as any electrocardiogram, complete blood count, serum chemistry, urine or serum drug screening, urine pregnancy, urinalysis, COVID-19, or thyroid function testing. We used generalized estimating equations to identify patient and hospital factors associated with medical clearance testing. Costs for medical clearance evaluation were estimated from billed charges.
Results:
Among 604 869 ED encounters, 56.9% had at least 1 medical clearance test conducted. Medical clearance testing varied substantially by hospital (range: 33.5% to 85.3% of ED encounters). Compared with encounters resulting in ED discharge, admission to a psychiatric unit at the same facility (aOR, 30.73; 95% CI, 21.73-43.47) and transfer to a psychiatric facility (aOR, 5.64; 95% CI, 4.01-7.92) were associated with greater odds of medical clearance testing. Medical clearance testing cost a total of $25 187 999 per year across the included hospitals.
Conclusions:
More than half of ED encounters for children with mental health concerns involved medical clearance testing and such practices varied across hospitals. Medical clearance testing in ED encounters for mental health-related concerns resulted in substantial and potentially unnecessary costs.
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