First10EM - By Justin Morgenstern - August 10, 2020
“Medical clearance” for psychiatric patients has long been a problem for emergency medicine. Despite a clear consensus in the medical literature and guidelines that routine laboratory testing is not required for psychiatric patients, many hospitals are still requiring this testing. (I know from first hand experience.) This is harmful to our patients, results in unnecessary delays in care, and is incredibly wasteful. I think we need to stop the practice as soon as possible...
There are certainly medical causes of psychiatric issues. Psychiatric patients are at high risk for a number of other medical issues. We need to assess these patients carefully, especially when they are unable to provide us with a clear history. However, there is clearly no role for routine testing. The history and physical will catch almost all important medical issues. Policies that require testing before patients are accepted by psychiatric teams hurt our patients, waste time and money, and take important resources away from other sick patients in the emergency department. This position is supported both by evidence and by guidelines from multiple major medical associations."