Not as helpful an article as I hoped when I pulled it to peruse. Part of the issue is the surveys are administered to psychiatry and emergency department residents regarding their evaluation of the patient, so you’re almost certain to have a lot more variability – not just in assessment, but in level of understanding of language and the process of acute psychiatric assessment.
Where I’m not surprised we have a low kappa with our psych colleagues are areas like mood disorders – as emergency physicians are looking more at threat to themselves, threat to others, acute psychosis, and other factors affecting their global level of function to determine whether they are safe for discharge. What’s interesting are the 2×2 tables regarding things like suicidality, where psychiatry is eliciting suicidality in a significant number of individuals where that was not reported by the emergency physician. Out in community practice where psychiatry is not always readily available, the discharge of psychiatry patients is a high-risk endeavor – and I would have expected the emergency physician to be more attuned to suicide risk and document a lot more concern for suicidality that was deemed not an issue for the consulting team.
Mostly just an article to read out of passing curiosity that won’t impact your practice.