Physical examination on admission to an acute psychiatric inpatient unit, how often is it done?

Abstract

Introduction

Certain studies in 1986 & 2004 reported that recording of physical examination carried out on admission by psychiatric trainees to be ‘uniformly poor’ to variable’.¹

Aims

The aim was to re-audit the recording of performing a physical examination on psychiatric inpatients at the time of admission.

Objective

To identify the reasons for the inability to physically examine psychiatric patients on admission.

Methods

We reviewed 30 case notes retrospectively each time, following admission, data was collected in December 2008 and June 2009. Ten patients from each ward (3 wards) were selected randomly.

Results

The percentage of patients having a physical examination on admission rose from 67% in December 2008 to 83% in July 2009. 13% of patients each were examined the next day, leaving 20% and 4% of the patients respectively, who were not examined within 72 hours of admission. The general trend (full & partial examination) in July 2009 was improving when compared to December 2009, with general inspection being done in 66% as compared to 56%, cardio-vascular examination 94% as compared to 77%, Respiratory examination 83% from 76%and central nervous system in 83% as compared to 63%. The rate of abdominal examination and baseline blood tests dropped from 73% to 67% and 93% to 73% respectively. 73% had baseline ECG in 2009 compared to 60% in 2008.

Conclusions

We are also looking at the availability of staff and examination equipments on the wards and suggest this should be the aim of future studies.