Discrepancy between diagnoses established by a specialized psychiatric emergency medical team and a psychiatric hospital in Krasnodar: structure, dynamics and prevention

Discrepancy between diagnoses established by a specialized psychiatric emergency medical team and a psychiatric hospital in Krasnodar: structure, dynamics and prevention

 

Authors

 

P.V. Sitchikhin

SBIH “Specialist Psychiatric Hospital no. 7” of the Ministry of Health of the Kuban, Krasnodar, Russian Federation

V.L. Gilev

SBIH “Specialist Psychiatric Hospital no. 7” of the Ministry of Health of the Kuban, Krasnodar, Russian Federation

 

https://doi.org/10.26617/1810-3111-2023-4(121)-52-60

 

Journal:Siberian Herald of Psychiatry and Addiction Psychiatry. 2023; 4 (121): 52-60.

 

Abstract

Introduction. The diagnosis established by the staff of psychiatric emergency medical teams (PT EMC) is the basis for the provision of emergency psychiatric care and hospitalization in a psychiatric hospital, therefore the importance of correct diagnosis at the prehospital stage cannot be overestimated. Objective:  to study the structure and dynamics of the discrepancy between diagnoses established by doctors of the PT EMC and doctors of a psychiatric hospital in Krasnodar. Materials. A non-randomized, non-interventional, single-center, retrospective cohort naturalistic study was performed at the Emergency Unit of the Krasnodar City Psychiatric Hospital. Using a continuous method, tear-off coupons were copied to the accompanying sheets of the ambulance station after the completion of the case of providing medical care to patients (n=1149) hospitalized by employees of the PT EMC in a psychiatric hospital and discharged within 12 months of 2022. Dynamics of the diagnosis discrepancy rate based on the materials of analytical reports, St. Petersburg No. 7 were considered between 1999 and 2022. Discrepancies were considered errors in making diagnoses of class V ICD-10 “Mental disorders and behavioral disorders” or the leading syndrome, which could affect treatment tactics or the profile of the Unit during hospitalization. Methods: clinical-psychopathological, follow-up and statistical. Statistical processing was performed using the package of applied statistical programs Statistica 6.1 (Stat Soft Inc., US). Results. The most common diagnoses: schizophrenia, schizotypal and delusional disorders (52.7%) and organic, including symptomatic, mental disorders (26.8%). A higher proportion of discrepancies in diagnoses was established in the diagnosis of mental and behavioral disorders due to the use of alcohol and psychoactive substances (15.7%) and organic mental disorders (12.0%) compared to schizophrenia spectrum disorders (2.8%). A comparison of frequencies between the discrepancy between diagnoses of section F20-F29 according to ICD-10 and diagnoses of other sections of mental disorders showed a statistically significant difference: organic mental (χ²=31.1, p<0.001), affective (χ²=45.1, p<0.001), neurotic (χ²=51.1, p<0.001), personality and behavioral disorders in adulthood (χ²=36.9, p<0.001), mental retardation (χ²=53.5, p<0.001), mental disorders and behavioral disorders due to the use of psychoactive substances (χ²=21.3, p<0.001). Statistical data confirmed a significant percentage of discrepancies in diagnoses in patients with affective and neurotic disorders, mental retardation and personality and behavioral disorders in adulthood. A strong negative statically significant correlation was revealed between the nosological representation in the structure of hospitalized patients and the frequency of discrepancies in diagnoses (r=-0.89, p=0.0068). In the context of reforming the system of personnel policy for emergency medical services personnel, the proportion of discrepancies in diagnoses had increased significantly. To improve the quality of professional knowledge and skills, training events were carried out to improve professional competence for psychiatrists at the PT EMC. Based on the results of the work during the year, it was possible to achieve a decrease in the average rate of discrepancies between diagnoses. Conclusion. The least difficulties among PT EMC employees were found in diagnosing schizophrenia spectrum disorders, organic, including symptomatic, mental disorders, mental and behavioral disorders due to the use of alcohol and psychoactive substances. To prevent subjective causes of diagnostic errors, active work was necessary to improve the qualifications of the staff of the PT EMC, including in cooperation with doctors of a psychiatric hospital.

 

Keywords:mental disorders, diagnostic discrepancies, specialist psychiatric emergency medical teams, hospitalization.

 

Article (pdf)

 

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Materials

 

For citation: Sitchikhin P.V., Gilev V.L. Discrepancy between diagnoses established by a specialized psychiatric emergency medical team and a psychiatric hospital in Krasnodar: structure, dynamics and prevention. Siberian Herald of Psychiatry and Addiction Psychiatry. 2023; 4 (121): 52-60. https://doi.org/10.26617/1810-3111-2023-4(121)-52-60

 

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