Retrospective Chart Review of the Triage Algorithm for Psychiatric Screening (TAPS) for Patients Who Present to Emergency Departments With Psychiatric Chief Complaints

Abstract

Session A presented Thursday, September 27, 10:00-11:00 am Purpose: The purpose of this quality improvement project is to replicate the Miller et.al (2012) study and evaluate if the TAPS tool can identify patients with an absence of a serious medical illness at a community teaching hospital ED with an on-site inpatient psychiatric unit. Design: A non-experimental, retrospective overlay of the TAPS tool was done to evaluate its value in the triage process. This quality improvement (QI) project is IRB exempt. Setting: This quality improvement project took place at a community teaching hospital ED with an on-site inpatient psychiatric unit. Participants/Subjects: A convenience sample was selected. Participants selected met a sample criterion. Sample criterion included: ED Indicator, Community Teaching Hospital with Psychiatry Unit, arrival date (7/31/15 - 1/31/17), age at arrival (18 years or older), mental disorders, and non-pregnant. Methods: IBM SPSS statistical software was used for statistical analyses. Alpha was set to .05. A G*power analysis was calculated and required a minimum of 26 charts to be audited. To determine if TAPS scores were related to LOS a Spearman’s rho correlation was conducted. The total cost per day for each patient was computed. Results/Outcomes: A total of 154 charts were initially considered for review. Descriptive statistics (n, %) for TAPS scores across the 101 patients was performed. A one-way ANOVA revealed no statistically significant differences in age, F (5, 95) = .73, p =.60. For systolic and diastolic blood pressure, TAPS score of 3 was significantly different than patients with a TAPS score of 0, 1, and 2. Follow-up comparisons (excluding TAPS = 5 due to only one patient being in this group) for pulse showed significant differences between TAPS of 0 and all other TAPS scoring groups (all p < .05). The overall sensitivity was 71.43% and the specificity was 32.98%. There were 31 patients with a TAPS of 0 that did not have clinically significant laboratory results and 2 patients that had clinically significant results. Chi square tests revealed no statistical significance (all p>.05) between TAPS score and laboratory results, with the exception of TAPS and serum drug screen. This was not a clinically significant finding. A Spearman’s rho correlation was calculated and the TAPS scores were not related to LOS in the ED (ρ=.141, p=.160). None of the patients who received a TAPS score of 0 (n=33) were admitted to a medical unit. Implications: High acuity, laboratory screening tests, and day costs all contribute to increasingly high costs when psychiatric patients are ‘boarded’ in the ED. Use of the TAPS tool can be a method to decrease costs and improve ED throughput30-32. Those patients who do not have indications for medical screening tests by the TAPS tool (TAPS of 0) could have a shorter time-to-psychiatry referral and overall ED LOS. A clinically meaningful workup for low-risk patients could include an i-STAT™ 6+ (potassium, glucose…..and a urine drug screen. Future considerations should include studying the TAPS tool at a trauma and rural hospital, as well as in the pediatric and addiction population.