|Title||Feasibility and effects of a Web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department.|
|Publication Type||Journal Article|
|Year of Publication||2010|
|Authors||Fein JA, Pailler ME, Barg FK, Wintersteen MB, Hayes K, Tien AY, Diamond GS|
|Journal||Archives of Pediatric Adolescent Medicine|
|Date Published||2010 Dec|
|Keywords||Adolescent, Adolescent Health Services, Emergency Service, Hospital, Emergency Services, Psychiatric, Feasibility Studies, Female, Humans, Internet, Male, Mass Screening, Mental Disorders, Psychiatric Status Rating Scales|
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.
|Alternate Journal||Arch Pediatr Adolesc Med|
|Grant List||H34MC04366 / / PHS HHS / United States|