An Evidence-Based Approach to Medical Clearance of Psychiatric Patients in the Emergency Department

Medical clearance of psychiatric patients is the process whereby emergency physicians (EP) screen for medical causes of psychiatric symptoms as well as incidental comorbid illnesses in order to appropriately dispose the patient to either a medical or psychiatric unit. There is much disagreement between EPs and psychiatrists regarding the extent of workup required. It is universally accepted that an adequate history and physical exam, including complete vital signs, mental status exam, and neurological exams are crucial to this process. However, several components of the H&P, particularly the mental status and neurological exam, are often omitted by the EP. Routine labs, imaging, and toxicological screening on all psychiatric patients are low yield, and these studies should instead be guided by the history and exam. Psychiatrists and EPs need to work together to streamline the medical screening process to be safe, efficient, and evidence based.