*Department of Pediatrics,BC Children's Hospital,Vancouver, BC.
CJEM. 2019 Jan;21(1):87-96. doi: 10.1017/cem.2018.1. Epub 2018 Mar 28.
To evaluate the psychometric properties of HEARTSMAP, an emergency psychosocial assessment and management tool, and its impact on patient care and flow measures.
We conducted the study in two phases: first validating the tool using extracted information from a retrospective cohort, then evaluating implementation on a prospective cohort of youth presenting with mental health complaints to a tertiary Pediatric Emergency Department (PED). In phase 1, six PED clinicians applied HEARTSMAP to extracted narratives and we calculated inter-rater agreement for referral recommendations using Cohen’s Kappa and the sensitivity and specificity for identifying youth requiring psychiatric consultation and hospitalization. In phase 2, PED clinicians prospectively used HEARTSMAP and we assessed the impact of the tool’s implementation on patient-related outcomes and Emergency department (ED) flow measures.
We found substantial agreement (κ=0.7) for cases requiring emergent psychiatric consultation and moderate agreement for cases requiring community urgent and non-urgent follow-up (κ=0.4 each). The sensitivity was 76% (95%CI: 63%, 90%) and specificity was 65% (95%CI: 55%, 71%) using retrospective cases. During pilot implementation, 62 patients received HEARTSMAP assessments: 46 (74%) of HEARTSMAP assessments triggered a recommendation for ED psychiatry assessment, 39 (63%) were evaluated by psychiatry and 13 (21%) were admitted. At follow-up, all patients with HEARTSMAP’s triggered recommendations had accessed community resources. For those hospitalized for further psychiatric care at their index or return visit within 30 days, 100% were initially identified by HEARTSMAP at the index visit as requiring ED psychiatric consultation.
HEARTSMAP has strong reliability, and when applied prospectively is a safe and effective management tool.
评估 HEARTSMAP 的心理测量学特性，这是一种紧急心理社会评估和管理工具，及其对患者护理和流程测量的影响。
我们分两个阶段进行了这项研究：首先使用回顾性队列中的提取信息验证该工具，然后在向三级儿科急诊部（PED）就诊的有心理健康问题的青年前瞻性队列中评估其实施情况。在第一阶段，六名 PED 临床医生应用 HEARTSMAP 对提取的叙述进行评估，我们使用 Cohen's Kappa 计算转诊建议的组内一致性，并计算识别需要精神科咨询和住院治疗的青年的敏感性和特异性。在第二阶段，PED 临床医生前瞻性地使用 HEARTSMAP，我们评估了该工具的实施对患者相关结局和急诊室（ED）流程测量的影响。
我们发现需要紧急精神科咨询的病例具有实质性的一致性（κ=0.7），需要社区紧急和非紧急随访的病例具有中等一致性（κ=0.4 每个）。使用回顾性病例，敏感性为 76%（95%CI：63%，90%），特异性为 65%（95%CI：55%，71%）。在试点实施期间，62 名患者接受了 HEARTSMAP 评估：46 名（74%）的 HEARTSMAP 评估触发了对 ED 精神病评估的建议，39 名（63%）接受了精神病评估，13 名（21%）住院。在随访时，所有有 HEARTSMAP 触发建议的患者都已获得社区资源。对于在索引就诊或 30 天内复诊时因进一步精神病治疗而住院的患者，100%在索引就诊时最初被 HEARTSMAP 识别为需要 ED 精神病咨询。
HEARTSMAP 具有很强的可靠性，当前瞻性应用时，是一种安全有效的管理工具。
