Abstract
To assess the impact of a 6-month emergency psychiatry training program on emergency psychiatric decision making, we studied 577 emergency psychiatric patient evaluations conducted by 15 first-year psychiatry residents. By their fifth month of training, the residents’ rates of emergency patient hospitalization declined from 33% to 19%. For residents in the early training phase, various clinical features, including psychosis, thought disorder, schizophrenic diagnosis, dangerousness, and overall symptoms, were associated with higher rates of patient hospitalization. By the end of training, only dangerousness and overall symptoms remained significantly related to the hospitalization decision. Specific training in emergency psychiatry may affect psychiatric decision-making practices as early as the first year of residency training.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Feigelson EB, Davis, EB, MacKinnon, R, et al: The decision to hospitalize. Am J Psychiatry 1978; 135:354–357
Friedman S, Feinsilver DL, Davis GW, et al: Decision to admit in an inner-city psychiatric emergency room: beyond diagnosis—the psychosocial factors. Psychiatr Q 1981; 53:259–274
Friedman S, Margolis R, David OJ, et al: Predicting psychiatric admission from an emergency room. J Nerv Ment Dis 1983; 171:155–158
Marson DC, McGovern MP, Pomp, HC: Psychiatric decision making in the emergency room: a research overview. Am J Psychiatry 1988; 145:918–925
Errera P, Wyshak G, Jarecki H: Psychiatric care in a general hospital emergency room. Arch Gen Psychiatry 1963; 9:105–112
Tischler GL: Decision-making process in the emergency room. Arch Gen Psychiatry 1966; 14:69–78
Baxter S, Chodorkoff B, Underhill R: Psychiatric emergencies: dispositional determinants and the validity of the decision to admit. Am J Psychiatry 1968; 124:1542–1548
Mendel WM, Rapport S: Determinants of the decision for psychiatric hospitalization. Arch Gen Psychiatry 1969; 20:321–328
Gerson S, Bassuk E: Psychiatric emergencies: an overview. Am J Psychiatry 1980; 137:1–11
Hulard JR, O’Srwnick GJ, Houpt JL: Residency training in the psychiatric emergency room. Am J Psychiatry 1982; 139:236–238
Fauman BJ: Psychiatric residency training in the management of emergencies. Psychiatr Clin North Am 1983; 6:325–334
Hoffman JA, Forssmann-Falck R: Emergency psychiatry training: the new old problem. Gen Hosp Psychiatry 1984; 6:143–145
McPherson DE: Teaching and research in emergency psychiatry. Can J Psychiatry 1984; 29:50–54
Ellison JM, Hughes DH, White KA: An emergency psychiatry update. Hosp Community Psychiatry 1989;40:250–260
Meyerson AT, Moss JZ, Belville R, et al: Influence of experience on major clinical decisions. Arch Gen Psychiatry 1979; 36:423–427
Hanson G, Babigian H: Reasons for hospitalization from a psychiatric emergency service. Psychiatr Q 1974;3:336–351
Streiner DL, Goodman JT, Woodward CA: Correlates of the hospitalization decision: a replicative study. Can J Public Health 1975; 66:411–415
Apsler R, Bassuk E: Differences among clinicians in the decision to admit. Arch Gen Psychiatry 1983; 40:1133–1137
Evenson R, Waite J, Holland R: Admission decisions in the psychiatric emergency room. Compr Psychiatry 1983; 24:90–93
Ianzito BM, Fine J, Sprague B, et al: Overnight admission for psychiatric emergencies. Hosp Community Psychiatry 1978; 29:728–730
Skodol AE, Karasu TB: Toward hospitalization criteria for violent patients. Compr Psychiatry 1980; 21:162–166
Friedman RS: Hospital treatment of psychiatric emergencies. Psychiatr Clin North Am 1983; 6:293–303
Way BB, Evans ME, Banks SM: Factors predicting referral to inpatient or outpatient treatment from psychiatric emergency services. Hosp Community Psychiatry 1992; 43:703–708
Norusis MJ: SPSS Advanced Statistics User’s Guide. Chicago, IL, SPSS Inc., 1990
McNiel DE, Myers RS, Zeiner HK, et al: The role of violence in decisions about hospitalization from the psychiatric emergency room. Am J Psychiatry 1992; 149:207–212
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Fichtner, C.G., Flaherty, J.A. Emergency Psychiatry Training and the Decision to Hospitalize. Acad Psychiatry 17, 130–137 (1993). https://doi.org/10.1007/BF03341515
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03341515