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Making Psychiatric Assessments in Emergency Rooms

Summary

Publications & Results

Press Releases & News Stories

Partners

Scope of Work

Contact Information

Summary
The New York Office of Mental Health partnered with CTG to improve emergency psychiatric decision making. The primary goals of the project were to reduce inappropriate admissions and discharges, improve client and system outcomes, and reduce inconsistencies in emergency room decisions. To achieve these goals, the project developed decision support software and sought to apply this improved technology in a very harried, complex, and significant decision environment - an environment that deprives individuals of their liberty and consumes significant government resources.

The decision support software was designed to ensure that physicians ask all the appropriate questions needed to make an admission decision, and to help them sort and weigh the relative importance of the answers. The admission decision, however, is the province of the physician. The software was not intended to, nor can it, replace physician judgment.

Expectations for the CTG project were ambitious. OMH hoped ultimately for a psychiatric assessment product that could be sent to the 166 hospitals in New York for potential use in their emergency rooms. The complexity of the tool and the policies it represents, however, point to the need for much additional testing and revision of the prototype.

Publications & Results
Reports and Working Papers (2)
Reports Cover
Supporting Psychiatric Assessments in Emergency Rooms
Wed, 01 Sep 1995 >Download PDF
With the assistance of an expert panel representing both practitioners and consumers of mental health services, a computer-assisted decision model was developed to support psychiatric assessments in emergency rooms.

Report of the Field Test to Evaluate a Decision Support Tool for Psychiatric Assessments in Emergency Rooms
Tue, 01 Aug 1995 >Download PDF
Field testing a prototype is critical to gauge its value for users. This report describes the results of the field test of a prototype decision support tool developed to help emergency physicians conduct psychiatric assessments.

Lessons Learned

The New York Office of Mental Health sought a project at CTG in order to improve emergency psychiatric decision making. The primary goals of the project were to reduce inappropriate admissions and discharges, improve client and system outcomes, and reduce inconsistencies in emergency room decisions. To achieve these goals, the project developed prototype decision support software and sought to apply this improved technology in a very harried, complex, and significant decision environment--an environment that deprives individuals of their liberty and consumes significant government resources.

Value to State and Local Government

Many public agencies are responsible for programs that try to meet the needs of a diverse set of stakeholders. This project illustrates some ways to address that diversity and to seek consensus on both policies and actions. It also gives some guidance on the value of information technology as a way to bring needed expertise to decision situations.

Press Releases & News Stories
Press Releases

Technology Aids Psychiatric Assessments
Wed, 01 Nov 1995


Partners
Lead Partners

Corporate Partners

Academic Partners

Center for Technology in Government

Participants

Expert Panel

Advisory Committee


Original Scope of Work
An inappropriate decision to admit or discharge a psychiatric patient from an emergency room is often the starting point for a series of undesirable results. The individual inappropriately admitted is deprived of liberty and involved in a disruptive, stigmatizing event. Since each admission to inpatient psychiatric care costs the mental health system about $10,000, these admissions are also a costly misuse of scarce health care dollars. The individual who is inappropriately discharged does not receive the care he or she needs, and, in extreme cases, may engage in dangerous or violent behavior in the community. Over 135,000 emergency psychiatric assessments are conducted in New York's hospitals each year, and research shows wide variability in the resulting admission and discharge decisions.

The project the Office of Mental Health (OMH) proposed to the Center for Technology in Government (CTG) was designed to address this issue through the development of a computer-assisted decision model to support psychiatric assessments in emergency rooms. The decision support model and software developed are not meant to replace the physician or the physician's own expert judgment. Instead, they support the practitioner in gathering and considering all information relevant to an admissions decision.

The first objective of the CTG project was the development of a formal decision model for use in psychiatric assessments in emergency rooms. An effective and workable model required not only careful study of relevant research, but also required a consensus among experts. The Center for Policy Research at the University at Albany applied its extensive facilitation experience to this project objective. A group of 15 experts was brought together three times (in May, July, and September 1994) to define and reach consensus on the decision model. A selected group of three experts met a fourth time, in April 1995, to evaluate the readiness of the prototype for a field test.

The decision model produced by this first phase of the project specified the most important information needed for a psychiatric assessment and a method for combining individual items of information to provide guidance for a disposition decision. This model specified relationships among various items of information to key summary indicators or modules.

They are:


The second objective was to create software for the decision model. This prototype system is a Microsoft Windows-based program that runs on a notebook computer and generates descriptive profiles for a client in each of the modules embodied in the model. These profiles are generated from users' answers to a set of approximately seventy-five questions about the client. Not all questions need be answered about a client; the system is capable of handling situations in which only partial information is available. The prototype system has two components: the user interface and the evaluation module. The user interface allows the clinician to supply information about the client. The evaluation module presents summary output in three formats: a scaled scoring, a graphical representation of those scores, and a short narrative analysis.

The third objective was to field test the software. A field evaluation comprised a first assessment of the structure, value, and usability of the tool in a hospital setting in one psychiatric ER. Evaluation results cover three topics: strengths and weaknesses of the prototype, its potential for future use, and general reaction to the technical aspects of the application.

Contact Information
Center for Technology in Government
University at Albany, SUNY
187 Wolf Road, Suite 301
Albany, NY 12205
(518) 442-3892 (phone)
(518) 442-3886 (fax)