Reliability of HEARTSMAP as a tool for evaluating psychosocial assessment documentation practices in emergency departments for pediatric mental health complaints.
Abstract
OBJECTIVES:
The goal of this study was to assess the reliability of HEARTSMAP as a standardized tool for evaluating the quality of psychosocial assessment documentation of pediatric mental health presentations to the emergency department. In addition, we report on current documentation practices.
METHODS:
We conducted a retrospective cross-sectional study of pediatric (up to age 17) mental health-related visits to four emergency departments between April 1, 2013 and March 31, 2014. The primary outcome was the inter-rater agreement when evaluating the completeness of pediatric emergency psychosocial assessments using the HEARTSMAP tool. The secondary outcome was to describe the adequacy of documentation of emergency pediatric mental health assessments, using HEARTSMAP as a guide for a complete assessment.
RESULTS:
A total of 400 medical records (100 from each site) were reviewed. We observed near perfect inter-rater agreement (κ = 0.99-1.00) regarding the presence of documentation and good to perfect agreement (κ = 0.71-1.00) regarding whether sufficient information was documented to score a severity level for every component of an emergency psychosocial assessment. Inter-rater agreement regarding whether referrals or resources were documented for identified needs was observed to be good to very good (κ = 0.62-0.98). Current psychosocial documentation practices were found to be inconsistent with significant variability in the presence of documentation pertaining to HEARTSMAP sections between medical centers, initial clinician assessor, and whether specialized mental health services were involved prior to discharge.
CONCLUSIONS:
The HEARTSMAP tool can be reliably used to assess pediatric psychosocial assessment documentation across a diverse range of emergency departments. Current documentation practices are variable and often inadequate, and the HEARTSMAP tool can aid in quality improvement initiatives to standardize and optimize care for the growing burden of pediatric mental illness. This article is protected by copyright. All rights reserved.
No comments:
Post a Comment