Appropriateness criteria of the psychiatry emergency

Abstract

Introduction. Emergency departments in the general hospitals undergo an steady and increasing overuse. The rate of inappropiated attendances ranges between a 20% and an 80% of the whole, according to the studies. Differences in the results are due to the lack of systematic application of the appropiateness protocols. This circumstance is common in medical and psychiatric emergencies. Nevertheless, there are validated protocols for general medical emergencies but not for psychiatric emergencies. Our objective is to design and validate a specific tool (PAUPH) aimed at identifiying the appropriate or inapropiate use of psychiatric emergencies services.

Material and methods. On a first stage, a mixed team composed by members from two general hospitals of different level designed this tool. The term «psychiatric emergency» was defined from the study of the literature and the team’s clinical experience. Next, we defined the objective criteria to evaluate the emergency of a psychiatric attendance and also the suitability of the setting where this was done. Accomplishment of any of the criteria identified the emergency’s appropriateness, while accomplishment of none of them identified inappropriateness. To evaluate the applicability of the protocol we retrospectively reviewed 100 psychiatric clínical reports randomly chosen from the attendances made in the emergency department.

Results. Our study shows a 23% of unappropriateness of the emergency department attendance. We describe the demographic profile of this reviewed attendances.

Discussion. The PAUPH is a tool easily appicable and it can be used in general hospital of different level to evaluate the appropriateness.