Letter to the Editor
Test or Not, No Difference in Adverse Outcomes
I agree with Sandra Scott Simons, MD, that what many behavioral health units require for psychiatric admission is unnecessary, expensive, and time-consuming. (“Psych Patients Don't Need Labs, ECGs, and CXRs,” EMN. 2019;41:1; http://bit.ly/3831jqn.) What is more, when a required medical test result is outside the lab's normal range but has no clinical significance, the admitting physician or his surrogate is often reluctant to accept a patient. Many times I have had to explain that I would be perfectly comfortable discharging him if he were not seeking or needing psychiatric admission.
I have worked in emergency departments that required lots of testing and in some that left it up to the EP to determine what was necessary. My anecdotal experience has been that there is no difference in adverse outcomes. That said, maybe someone should do a formal study: psychiatric admission protocol v. the EP's clinical judgment of what is necessary.
David Zlotowski, MD, MBA
Malvern, PACopyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.