Variations in Medical Clearance Testing for Mental Health Emergency Department Visits.

Abstract

There are recommendations against routine medical clearance testing for children evaluated in the emergency department (ED) for mental health concerns. Our objective was to determine variation, factors, and costs associated with medical clearance testing during ED encounters for mental health concerns. We conducted a cross-sectional study of ED encounters among children aged 5 to 18 years who presented to 35 US children's hospitals for mental health concerns (2016-2023). We determined the prevalence of medical clearance testing defined as any electrocardiogram, complete blood count, serum chemistry, urine or serum drug screening, urine pregnancy, urinalysis, COVID-19, or thyroid function testing. We used generalized estimating equations to identify patient and hospital factors associated with medical clearance testing. Costs for medical clearance evaluation were estimated from billed charges. Among 604 869 ED encounters, 56.9% had at least 1 medical clearance test conducted. Medical clearance testing varied substantially by hospital (range: 33.5% to 85.3% of ED encounters). Compared with encounters resulting in ED discharge, admission to a psychiatric unit at the same facility (aOR, 30.73; 95% CI, 21.73-43.47) and transfer to a psychiatric facility (aOR, 5.64; 95% CI, 4.01-7.92) were associated with greater odds of medical clearance testing. Medical clearance testing cost a total of $25 187 999 per year across the included hospitals. More than half of ED encounters for children with mental health concerns involved medical clearance testing and such practices varied across hospitals. Medical clearance testing in ED encounters for mental health-related concerns resulted in substantial and potentially unnecessary costs.