Emergency department psychiatric assessment for adults discharged with a principal diagnosis of schizophrenia in Maryland community hospitals with and without inpatient psychiatric units

For centuries, people with mental disorders in the United States (U.S.) have faced healthcare service delivery challenges. As the number of individuals with mental disorders continues to increase, the New Freedom Commission and the Institute of Medicine (IOM) have called for a restructuring of the U.S. healthcare system to meet the needs of this population. In the interim, the emergency department (ED) has become an important component of service delivery to individuals with mental disorders. As the number of individuals with mental disorders and no means to meet their healthcare needs continues to grow, costly ED use by this population also continues to rise. The American Psychiatric Association (APA) Practice Guideline for Treatment of Patients with Schizophrenia recommends a psychiatric history and mental status examination be conducted for individuals who present to the ED with mental disorders. Understanding the frequency of psychiatric assessment in the ED for individuals with mental disorders is critical to solving the overwhelming problem of meeting service delivery challenges for this population. This cross-sectional secondary-data analysis used 2004 data from the Healthcare Cost and Utilization Project (HCUP)/ State Emergency Department Database (SEDD) and the American Hospital Association Annual Survey (AHA). Significant differences existed between the frequencies of psychiatric assessments of adults aged 18 to 64 with schizophrenia who were discharged directly from an ED in a hospital with or without an inpatient psychiatric unit (IPU). The psychiatric assessment considered was that documented as a psychiatric diagnostic interview examination (PDIE) using Current Procedural Terminology (CPT) code 90801