Drug Screens for Psychiatric Patients in the Emergency Department: Evaluation and Recommendations

ObjectiveTo better understand how toxicology screening for psychiatric patients in the emergency department (ED) setting affects diagnostic decisions.MethodsRetrospective chart review of 439 ED visits of adult patients receiving psychiatry consultations at two hospitals, one an academic medical center (n =224) and the other a community hospital (n = 220), between July 2008 and February 2009. Clinical, demographic, and ED length of stay (LOS) information was abstracted from the psychiatry consultation notes and the medical records.ResultsPositive urine toxicology results, when combined with a basic substance abuse history, were not associated independently with a patient's receiving a substance-related diagnosis as part of the psychiatric assessment. By contrast, a positive blood alcohol level was associated independently with a patient's receiving one of these diagnoses while a positive alcohol use history was not.ConclusionsUrine toxicology screens do not add significant diagnostic value to all ED psychiatric evaluations when combined with standard substance use histories.