Literature suggests little standardization in the practice of medical clearance of patients who present to emergency rooms in psychiatric crisis. The present quality improvement study examined current practice in a large psychiatric teaching hospital setting. Using chart review, the completeness of physical examination was examined for 10 body areas in a random sample of 20 psychiatric patients admitted via a psychiatric emergency department (ED) during a one-month period. Charts were examined for four professional groups – family physicians or nurse practitioners, psychiatry residents, medical students and general ED physicians. Results indicated a wide variation in documentation across the four groups and some body systems that were consistently never assessed. To improve standardization, a physical examination form is proposed that is user friendly and based on a review of current literature.
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