Diagnostic Overshadowing of the Psychiatric Population in the Emergency Department: Physiological Factors Identified for an Early Warning System.

BACKGROUND: Many people with mental disorders in the United States remain either medically untreated or inadequately treated, which is often attributed to diagnostic overshadowing, a common occurrence across the nation in emergency departments. OBJECTIVE: The aim of this research is to create a tool that supports accurate assessment and distinguishing behavioral symptoms between psychiatric illness and coexisting medical conditions in the emergency department, thus leading to appropriate care and placement. DESIGN: Retrospective cohort design of 133 psychiatric admissions were reviewed between the years 2011 and 2015. RESULTS: Logistic regression retained three factors: age greater than 70 years (odds ratio [OR] = 6.575, 95% confidence interval [CI] = 2.58-16.76), abnormal heart rate (OR = 8.48, 95% CI = 3.39-28.42), and abnormal temperature (OR = 9.82, 95% CI = 3.91-18.40). The three factors were then placed into a screening tool. The presence of each factor equaled 1 point. If the total score was greater than 2, the sensitivity of the tool was 68.7% and the specificity of the tool was 85.8%. CONCLUSIONS: Coexisting medical conditions in the psychiatric population may present as behavioral symptoms; however, the use of a tool that focuses assessment toward medical factors such as abnormal heart rate, abnormal temperature, and advanced age can direct further investigation of behavioral symptoms.

Development of the Edmonson Psychiatric Fall Risk Assessment Tool.

The purpose of this study was to develop a fall risk assessment instrument for the inpatient psychiatric population. Nine risk factors were identified through a review of the literature. The instrument was applied retrospectively to patient records, and the percentage of those who fell who triggered each of the items in each domain was calculated. The expected value of the population and weighting system were established. The Morse Fall Scale and Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) were administered simultaneously to inpatient psychiatric patients. Sensitivity of the EPFRAT was 0.63, compared with 0.49 for the Morse Fall Scale; specificity of the EPFRAT was 0.86, compared with 0.85 for the Morse Fall Scale. Initial psychometric testing of the EPFRAT indicates the instrument is more sensitive in assessing fall risk in the acutely ill psychiatric population than those currently available. Additional psychometric testing is needed to determine the reliability and validity of the EPFRAT.