TY  - JOUR
T1  - FEasibility and effects of a web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department
AU  - Fein JA, Pailler ME, Barg FK, et al
Y1  - 2010/12/01
N1  - 10.1001/archpediatrics.2010.213
JO  - Archives of Pediatrics & Adolescent Medicine
SP  - 1112
EP  - 1117
VL  - 164
IS  - 12
N2  - Objectives 
    To determine the adoption rate of the Web-based Behavioral Health Screening–Emergency Department (BHS-ED) system during routine clinical practice in a pediatric ED, and to assess this system's effect on identification and assessment of psychiatric problems.Design 
    Descriptive design to evaluate the feasibility of a clinical innovation.Setting 
    The ED of an urban tertiary care children's hospital.Participants 
    Adolescents from 14 to 18 years of age, without acute or critical injuries or illness, presenting with nonpsychiatric symptoms.Intervention 
    The ED clinical staff initiated the use of the BHS-ED system, which identifies and assesses adolescents for depression, suicidal ideation, posttraumatic stress, substance use, and exposure to violence. Treating clinicians reviewed results and followed routine care practices thereafter.Main Outcome Measures 
    Adoption rate of the BHS-ED system by nursing staff, identification rates of occult psychiatric problems, and social worker or psychiatrist assessment. Data were collected for 19 months before implementation of the BHS-ED system and for 9 months during implementation.Results 
    Of 3979 eligible patients, 1327 (33.4%) were asked by clinical staff to get screened using the BHS-ED; of these 1327 patients, 857 (64.6%) completed the screening and 470 (35.4%) refused. During implementation, identification of adolescents with psychiatric problems increased significantly (4.2% vs 2.5%; odds ratio [OR],1.70; 95% confidence interval [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 patients who were screened with the BHS-ED, 90 (10.5%) were identified as having psychiatric problems (OR, 4.58; 95% CI, 3.53-5.94), and 71 (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. This can lead to small but significant increases in the identification of unrecognized psychiatric problems.
SN  - 1072-4710
M3  - doi: 10.1001/archpediatrics.2010.213
UR  - http://dx.doi.org/10.1001/archpediatrics.2010.213
ER  -