Routine investigations for patients with mental and behavioural disturbances

BACKGROUND: The process of medical clearance aims to exclude a general medical condition as an underlying cause for mental and behavioural disorders and involves routine screening with special investigations. Current evidence, however, suggests that clinician gestalt should guide the need for special investigations and that there is no benefit to routine screening. AIM: This study aimed to determine the effectiveness of and adherence to the Western Cape (WC) provincial guidelines for routine investigations of adult patients with behavioural disturbances. SETTING: This study was conducted at Mitchells Plain Hospital in Cape Town, South Africa. METHODS: This descriptive study was conducted at Mitchells Plain Hospital in Cape Town, South Africa. Data were collected from existing electronic registries over a 6-month period. Adult mental healthcare users were risk stratified into the probability of having a general medical condition and the results of their special investigations were described against their outcome. RESULTS: Of the 688 patients included in this study, 66% had abnormal vital signs and of the 312 patients who received special investigations, 56% were abnormal, including 18% who were clinically significantly abnormal. Abnormal special investigations changed the clinical outcome for 3 (<1%) patients. Adherence to the guidelines was reasonable (82%) but non-adherence resulted in unnecessary investigations. CONCLUSION: The results of this study support the existing evidence that clinical assessment and clinician gestalt should guide the need for special investigations and that there is no benefit to routine screening in the emergency centre (EC). The results also demonstrate that non-adherence rarely changed patient outcomes. CONTRIBUTION: This study provides information on the value of routine screening investigations in ECs.