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

Abstract

© 2017 Emergency Nurses Association. Introduction: There is a growing number of mental health illnesses (MHIs) in the nation and no standardization of the medical screening examination (MSE) in the emergency department. Many health care organizations are at the tipping point of discarding a battery of laboratory workups. A triage tool-specific to psychiatric chief complaints and cost effective-is needed for the emergency department. Methods: A nonexperimental, retrospective overlay of the Triage Algorithm for Psychiatric Screening (TAPS) onto previous psychiatric patients' records was performed to determine the sensitivity and specificity of the TAPS in ruling out acute medical illness. The laboratory test results, length of stay (LOS), and cost of treatment for all psychiatric patients were examined to determine if there was a correlation with their TAPS scores or if the use of the TAPS would have resulted in efficient care and cost savings. Results: This study shows the TAPS tool can be used reliably to rule out acute medical illness in patients with psychiatric chief complaints in a community hospital setting with an on-site inpatient psychiatric unit. The TAPS tool appropriately identified low-acuity patients without significant medical illness (TAPS of 0). As such, the TAPS tool could be used in selected settings to expedite psychiatric care and reduce unnecessary laboratory testing. Implications for Practice: The results of this project represent a valuable step forward in improving the triage of adult patients who present to the emergency department with psychiatric chief complaints. A reproducible study of the TAPS method was the next practice step in determining feasibility. Use of the TAPS tool can be a method to decease costs and ED crowding. For research and quality improvement projects in the future, addiction chief complaints should be treated as a separate category from psychiatric or medical complaints, as they meet the criteria of both.Image 1 Contribution to Emergency Nursing Practice •The TAPS tool can be used reliably to rule out acute medical illness in patients with psychiatric chief complaints in community hospital settings with on-site inpatient psychiatric units.•The TAPS tool appropriately identified low-acuity patients without significant medical illness (TAPS of 0).•Addiction chief complaints was a confounding variable because these patients often had mental health complaints in addition to medical complaints. The TAPS tool is a simple and cost-effective tool to use in the emergency department during triage.•The TAPS tool could be used in selected settings to expedite psychiatric care and reduce unnecessary laboratory testing.