Deployment, supervision and decision-making of residents in an emergency psychiatric service.

A lessening of personal discomfort felt by residents on-call in the Emergency Psychiatric Service has resulted from changes in the frequency of being on-call, exclusion of beginning residents from duty and arranging for the presence of a faculty psychiatrist for one or two hours during each on-call period. Coincidental significant reductions in the number of cases admitted to hospital and reductions in the proportion of discrepancies between diagnoses made by the emergency resident and those made later by inpatient unit staff have been described. The relationship of the changes in resident experience to the reduction in admissions and decreased proportion of diagnostic discrepancy has been discussed using a model of the process of emergency psychiatric admission described earlier by Bartolucci et al. (1). Less isolation, anxiety and some increased experience on the part of the psychiatric residents on duty in the Emergency Psychiatric Service results in greater awareness and better appraisal of the non-medical aspects of psychiatric emergencies.