Objective: Determine the adoption rate of the web-based Behavioral Health Screening- Emergency Department (BHS-ED) system into routine clinical practice in a pediatric emergency department (ED), and assess its impact on identification and assessment of psychiatric problems.
Design: Descriptive design to evaluate feasibility of a clinical innovation.
Setting: ED of an urban tertiary care children’s hospital.
Participants: Non-acute, non-critical 14-18 year olds presenting with non-psychiatric complaints.
Intervention: ED clinical staff initiated the BHS-ED which assesses depression, suicide, post-traumatic stress, substance use, and violence exposure. Treating clinicians reviewed results and followed routine care practices thereafter.
Outcome Measures: Adoption rate of the BHS-ED by nursing staff, identification rates of occult psychiatric problems, and social worker or psychiatrist assessment. Data were collected for 19 months before and 9 months during implementation.
Results: Of 3979 eligible patients, 1327 (33%) were approached by clinical staff to complete the BHS-ED; of these, 857 (64.6%) completed the BHS-ED, and 470 (35.4%) refused. During implementation, identification of adolescents with psychiatric problems significantly increased (4.2% vs. 2.5%, OR=1.70, 95% CI 1.38, 2.10) as did ED assessments by a social worker or psychiatrist (2.5% vs. 1.7%, OR 1.47, 95% CI 1.13, 1.90). Of the 857 subjects who completed the BHS-ED, 10.5% were identified (OR=4.58, 95% CI 3.53, 5.94) and 8.3% were assessed (OR 5.12, 95% CI 3.80, 6.88).
Conclusions: In a busy pediatric ED, computerized, self-administered adolescent behavioral health screening can be incorporated into routine clinical practice and can lead to small but significant increases in the identification of unrecognized psychiatric problems.
Fein, M.D. M.P.H, Joel A.; Pailler, Ph.D, Megan E.; Barg, Ph.D. M.Ed., Frances K.; Wintersteen, Ph.D, Matthew B.; Hayes, B.S, Katie; Tien, M.D., M.H.S, Allen Y.; and Diamond, Ph.D, Guy S., "Feasibility and Impact of an Internet-based Adolescent Psychiatric Assessment Administered by Clinical Staff in the Pediatric Emergency Department" (2010). Department of Psychiatry and Human Behavior Faculty Papers. Paper 10.
Available for download on Saturday, January 01, 3200