@article{ref1,
title="Utility of nonspecific laboratory testing for psychiatric patients undergoing medical screening in a military emergency department",
journal="Military medicine",
year="2020",
author="Tobin, Michael R. and Hartline, James R. and Sullivan, Scott B. and Kang, Christopher S. and Devita, Diane",
volume="185",
number="11-12",
pages="e1941-e1945",
abstract="INTRODUCTION: Psychiatric complaints account for a sizable and increasing portion of emergency department (ED) visits. Compared with other medical patients, these  patients often require substantial resources because of limited specialized  resources and prolonged boarding times, which can be detrimental to the safety and  satisfaction of other patients. This can prompt early and indiscriminate laboratory  testing to expedite early requests for admission consideration. Numerous emergency  medicine literature and clinical policies already recommend against indiscriminate  screening labs for these patients, yet many psychiatric services require these  tests. This study further evidences the limited clinical utility and high associated  costs of mandatory protocol screening labs for psychiatric patients evaluated in  military EDs. <br><br>MATERIALS AND METHODS: A retrospective chart review of 441 active duty  military patients and their families presenting to Madigan Army Medical Center's ED  who received psychiatric diagnoses underwent analysis. A 3-physician review panel  evaluated each identified patient case to confirm eligibility and determine whether  or not laboratory studies led to a change in patient disposition that was not  identified by history, review of systems, physical exam, and known past medical  history. The review was approved by the hospital's institutional review board. Contemporary laboratory tests ordered in the evaluation of these patients included  complete blood count with differential, complete metabolic panel,  thyroid-stimulating hormone, serum ethanol, serum acetaminophen, serum salicylates,  urine drug screening, urinalysis, urine human chorionic gonadotropin, and  electrocardiograms. <br><br>RESULTS: Broad screening labs may have altered dispositions for  0.9% (4) of patients. In total, 93% (202) of admitted patients were dispositioned to  a psychiatric service. Of the 15 patients admitted to a medical service, 10 involved  overdoses or intoxication. One patient had anemia in addition to opioid use disorder  as diagnoses and was dispositioned to a medicine service. One pediatric patient was  admitted for observation only. The remaining patients had diagnoses based on  physical exam and history requiring medical service admission. In total, 7 patients  had unknown dispositions, of which 4 carried solely psychiatric diagnoses. <br><br>CONCLUSIONS: The cumulative reimbursement costs of broad testing in the studied  population were estimated at $36,325.17 and rarely altered patient disposition. Further testing does not increase the incidence of disposition altering diagnoses  and is associated with increased costs. When individual state laws and the clinical  assessment by the responsible emergency physician are considered, future  standardized ED lab screening evaluations of psychiatric patients in military EDs  may be concentrated to breathalyzer alcohol level, urine drug screen, serum  salicylates, serum acetaminophen, and urine human chorionic gonadotropin.<p /> <p>Language: en</p>",
language="en",
issn="0026-4075",
doi="10.1093/milmed/usaa163",
url="http://dx.doi.org/10.1093/milmed/usaa163"
}