Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Child and Adolescent Psychiatry, Department of Psychiatry, BC Children's Hospital, Vancouver, British Columbia, Canada.
Acad Emerg Med. 2018 Dec;25(12):1375-1384. doi: 10.1111/acem.13506. Epub 2018 Aug 16.
The goal of this study was to assess the reliability of HEARTSMAP as a standardized tool for evaluating the quality of psychosocial assessment documentation of pediatric mental health (MH) presentations to the emergency department (ED). In addition, we report on current documentation practices.
We conducted a retrospective cross-sectional study of pediatric (up to age 17) MH-related visits to four EDs between April 1, 2013, and March 31, 2014. The primary outcome was the inter-rater agreement when evaluating the completeness of pediatric emergency psychosocial assessments using the HEARTSMAP tool. The secondary outcome was to describe the adequacy of documentation of emergency pediatric MH assessments, using HEARTSMAP as a guide for a complete assessment.
A total of 400 medical records (100 from each site) were reviewed. We observed near-perfect inter-rater agreement (κ = 0.99-1.00) regarding the presence of documentation and good-to-perfect agreement (κ = 0.71-1.00) regarding whether sufficient information was documented to score a severity level for every component of an emergency psychosocial assessment. Inter-rater agreement regarding whether referrals or resources were documented for identified needs was observed to be good to very good (κ = 0.62-0.98). Current psychosocial documentation practices were found to be inconsistent with significant variability in the presence of documentation pertaining to HEARTSMAP sections between medical centers and initial clinician assessor and whether specialized MH services were involved prior to discharge.
The HEARTSMAP tool can be reliably used to assess pediatric psychosocial assessment documentation across a diverse range of EDs. Current documentation practices are variable and often inadequate, and the HEARTSMAP tool can aid in quality improvement initiatives to standardize and optimize care for the growing burden of pediatric mental illness.
本研究旨在评估 HEARTSMAP 作为一种评估儿科精神健康（MH）就诊至急诊部（ED）时心理社会评估文件质量的标准化工具的可靠性。此外，我们还报告了当前的文件记录实践。
我们对 2013 年 4 月 1 日至 2014 年 3 月 31 日期间，4 家 ED 接诊的 400 名儿科（年龄不超过 17 岁）MH 相关就诊者进行了回顾性横断面研究。主要结局是使用 HEARTSMAP 工具评估儿科急诊心理社会评估的完整性时的组内一致性。次要结局是使用 HEARTSMAP 作为完整评估指南，描述急诊儿科 MH 评估的文件记录的充分性。
共查阅了 400 份病历（每个站点 100 份）。我们观察到关于存在文件记录的近乎完美的组内一致性（κ=0.99-1.00），以及对于每个急诊心理社会评估组成部分的评分严重程度，是否记录了足够的信息的良好至完美一致性（κ=0.71-1.00）。对于记录识别出的需求的转诊或资源的组内一致性，观察到良好至非常好（κ=0.62-0.98）。发现当前的心理社会文件记录实践不一致，不同医疗中心和初始临床评估者的 HEARTSMAP 各部分的文件记录存在显著差异，以及在出院前是否涉及专门的 MH 服务。
HEARTSMAP 工具可用于可靠地评估来自不同 ED 的儿科心理社会评估文件记录。当前的文件记录实践具有变异性，且通常不充分，HEARTSMAP 工具可以辅助质量改进计划，以标准化和优化儿科精神疾病日益增长的负担的护理。
