Feasibility and effects of a Web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department.

TitleFeasibility and effects of a Web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department.
Publication TypeJournal Article
Year of Publication2010
AuthorsFein JA, Pailler ME, Barg FK, Wintersteen MB, Hayes K, Tien AY, Diamond GS
JournalArchives of Pediatric Adolescent Medicine
Volume164
Issue12
Pagination1112-7
Date Published2010 Dec
ISSN1538-3628
KeywordsAdolescent, Adolescent Health Services, Emergency Service, Hospital, Emergency Services, Psychiatric, Feasibility Studies, Female, Humans, Internet, Male, Mass Screening, Mental Disorders, Psychiatric Status Rating Scales
Abstract

OBJECTIVES: To determine the adoption rate of the Web-based Behavioral Health Screening-Emergency Department (BHS-ED) system during routine clinical practice in a pediatric ED, and to assess this system's effect on identification and assessment of psychiatric problems.

DESIGN: Descriptive design to evaluate the feasibility of a clinical innovation.

SETTING: The ED of an urban tertiary care children's hospital.

PARTICIPANTS: Adolescents from 14 to 18 years of age, without acute or critical injuries or illness, presenting with nonpsychiatric symptoms.

INTERVENTION: The ED clinical staff initiated the use of the BHS-ED system, which identifies and assesses adolescents for depression, suicidal ideation, posttraumatic stress, substance use, and exposure to violence. Treating clinicians reviewed results and followed routine care practices thereafter.

MAIN OUTCOME MEASURES: Adoption rate of the BHS-ED system by nursing staff, identification rates of occult psychiatric problems, and social worker or psychiatrist assessment. Data were collected for 19 months before implementation of the BHS-ED system and for 9 months during implementation.

RESULTS: Of 3979 eligible patients, 1327 (33.4%) were asked by clinical staff to get screened using the BHS-ED; of these 1327 patients, 857 (64.6%) completed the screening and 470 (35.4%) refused. During implementation, identification of adolescents with psychiatric problems increased significantly (4.2% vs 2.5%; odds ratio [OR], 1.70; 95% confidence interval [CI], 1.38-2.10), as did ED assessments by a social worker or psychiatrist (2.5% vs 1.7%; OR, 1.47; 95% CI, 1.13-1.90). Of the 857 patients who were screened with the BHS-ED, 90 (10.5%) were identified as having psychiatric problems (OR, 4.58; 95% CI, 3.53-5.94), and 71 (8.3%) were assessed (OR, 5.12; 95% CI, 3.80-6.88).

CONCLUSIONS: In a busy pediatric ED, computerized, self-administered adolescent behavioral health screening can be incorporated into routine clinical practice. This can lead to small but significant increases in the identification of unrecognized psychiatric problems.

DOI10.1001/archpediatrics.2010.213
Alternate JournalArch Pediatr Adolesc Med
PubMed ID21135339
Grant ListH34MC04366 / / PHS HHS / United States