Did you know that screening laboratory tests in the medical clearance process of pediatric patients who require inpatient psychiatric admission are not recommended unless clinically indicated?
This video discusses why we don’t need labs for most children and adolescents who are being admitted to an inpatient mental health facility via an admittedly silly (but representative) conversation. The incidence of mental health problems in children has increased in the last two decades, with suicide surpassing homicide as the second leading cause of death in teenagers. Most children with acute mental health issues do not have underlying medical etiologies for these symptoms. A large body of evidence, in both adults and children, has shown that routine laboratory testing without clinical indication is unnecessary and adds to health care costs. Any diagnostic testing should be based on a thorough history and physical examination. Universal requirements for routine testing should be abandoned.
You can learn more about the Choosing Wisely Pediatric Emergency Medicine recommendations here:
Is the AAP working with inpatient psych facilities or state run agencies to convince them these labs are not helpful?
This has been an issue for years and it’s good to see some advocacy directed towards this. But it also feels like the advocacy is totally misguided — you don’t need to convince PEM docs or probably pediatricians either about this. What is being done to convince the leaders of Child Psychiatry societies to accept this perspective? They are the ones who ultimately decide whether labs are needed or not — their institutions continue to refuse patients every time I try to transfer one to them without labs. Are there working groups with Psych on this? Are we developing a policy statement? Are we working with insurance companies to stop reimbursement for these unnecessary labs? In the meantime, I will keep getting the labs in order to be able to get patients out of the ED and to the place they need to go, fully well knowing they are an absolute waste.
Thank you Indi and Jacinta – couldn’t e more that the interventions need to be at the level of professional socialites, the joint commission, and regional healthcare leaders. Shabnam Jain and Shilpa Patel made that quite clear in our recent podcast interview. Jacinta, the AAP has written on this and there are US Preventative Services task forces (https://www.uspreventiveservicestaskforce.org/uspstf/search_results?searchterm=Psychiatry) but most of the work has still been local and regional. Indi – your questions are well founded, there is some successful work regionally but the Choosing Wisely experts would argue that broad recommendations and consensus statements aren’t there yet. We need to reset the scale of interventions to the patients and families before they reach the ED in the first place. Everything else is just a bandaid, which we are using to cover the site of the blood draw for medical clearance.