PC1233: Implementation of a Medical Clearance Algorithm for Psychiatric Emergency Patients

Purpose/Objectives: Clinicians are frequently asked to medically clear children presenting with psychiatric emergencies. Despite multiple studies demonstrating that routine laboratory testing does not change management or disposition in patients who don’t have an abnormal physical exam or vital signs, many clinicians still perform laboratory testing. We sought to reduce routine laboratory testing as a part of medical clearance for children with psychiatric emergencies.

Design/Methods: We developed and implemented a medical clearance algorithm at a large, urban, academic pediatric emergency department. Our primary outcome was a reduction in routine laboratory testing for all children with psychiatric emergencies. Our balancing measure was the number of patients requiring transfer from the inpatient psychiatry unit to a medical service.

Results: Prior to the introduction of the new medical clearance algorithm, 93% (n=547) of children with psychiatric emergencies received laboratory testing. After implementation of the medical clearance algorithm, 19.6% (n=158) of children with psychiatric emergencies received laboratory testing. Despite a decreased rate of routine testing, there were no safety events reported.

Conclusion/Discussion: Implementation of a medical clearance algorithm can decrease routine laboratory testing without increasing adverse events. Reducing unnecessary laboratory testing also has the potential to decrease emergency department length of stay, decrease cost, decrease unnecessary trauma to the patient, and decrease physical risks to staff.