Medford-Davis Laura N, Moukaddam Nidal, Matorin Anu, Shah Asim, Tucci Veronica
Ben Taub General Hospital Emergency Center, Baylor College of Medicine, Houston, TX, USA.
Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA.
J Emerg Trauma Shock. 2018 Apr-Jun;11(2):130-134. doi: 10.4103/JETS.JETS_125_16.
Medical clearance is required to label patients with mental illness as free of acute medical concerns. However, tests may extend emergency department lengths of stay and increase costs to patients and hospitals. The objective of this study was to determine how knowledgeable emergency and psychiatric providers are about the costs of tests used for medical clearance.
We surveyed the department of psychiatry (Psych) and department of emergency medicine (EM) faculty and residents to obtain their estimates of the costs of 18 laboratory/imaging studies commonly used for medical clearance. Survey responses were analyzed using the Wilcoxon signed-rank test to compare the median cost estimates between residents and faculty in EM and Psych.
A total of 99 physicians (response rate, 47.8%) completed the survey, including 47 faculty (EM = 28; Psych = 20) and 52 residents (EM = 29; Psych = 23). Across all the groups, cost estimates for tests were inaccurate, off by several hundred dollars for three tests, and by $13-$80 for 15. Significant differences between EM and Psych providers for estimated median costs of specific tests included between residents for urine drug screens (EM: $800; Psych: $50; < 0.0001) and ECG (EM: $25; Psych: $75; = 0.004); between faculty for urinalysis (EM: $40; Psych: $18; = 0.020) and urine drug screen (EM: $100; Psych: $10; < 0.0001); and between all physicians for urine drug screen (EM: $500; Psych: $50; < 0.0001).
Further education on the financial costs of medical clearance is needed to inform workup decisions and consensus between emergency and psychiatric providers.
要将患有精神疾病的患者标记为没有急性医疗问题，需要进行医疗检查。然而，检查可能会延长急诊科的住院时间，并增加患者和医院的费用。本研究的目的是确定急诊和精神科医生对用于医疗检查的检查费用了解多少。
我们对精神科（Psych）和急诊科（EM）的教职员工及住院医师进行了调查，以获取他们对常用于医疗检查的18项实验室/影像学检查费用的估计。使用Wilcoxon符号秩检验分析调查回复，以比较急诊和精神科住院医师与教职员工之间的中位费用估计值。
共有99名医生（回复率为47.8%）完成了调查，其中包括47名教职员工（急诊 = 28名；精神科 = 20名）和52名住院医师（急诊 = 29名；精神科 = 23名）。在所有组中，检查费用估计不准确，三项检查相差数百美元，15项检查相差13至80美元。急诊和精神科医生在特定检查的估计中位费用上存在显著差异，包括住院医师在尿液药物筛查（急诊：800美元；精神科：50美元；<0.0001）和心电图（急诊：25美元；精神科：75美元；=0.004）方面；教职员工在尿液分析（急诊：40美元；精神科：18美元；=0.020）和尿液药物筛查（急诊：100美元；精神科：10美元；<0.0001）方面；以及所有医生在尿液药物筛查（急诊：500美元；精神科：50美元；<0.0001）方面。
需要对医疗检查的财务成本进行进一步教育，以便为检查决策以及急诊和精神科医生之间的共识提供信息。
