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Brief Reports   |    
Interprofessional Differences in Disposition Decisions: Results From a Standardized Web-Based Patient Assessment
Tristan Gorrindo, M.D.; Elizabeth Goldfarb, B.A.; Lydia Chevalier, B.S.; Bettina B. Hoeppner, Ph.D., M.S.; Robert J. Birnbaum, M.D., Ph.D.; Benjamin Meller, B.S.; Jonathan E. Alpert, M.D., Ph.D.; John Herman, M.D.; Anthony P. Weiss, M.D., M.B.A.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200461
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With the exception of Dr. Hoeppner, all authors are affiliated with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Hoeppner is with the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. Send correspondence to Dr. Gorrindo, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Suite 700, Boston, MA 02114 (e-mail: tristan.gorrindo@mgh.harvard.edu).

Copyright © 2013 by the American Psychiatric Association


Objective  This study examined differences in disposition decisions among mental health professionals using a standardized Web-based simulation.

Methods  Using a Web-based simulation that described, across users, the same complex psychiatric patient, credentialed clinicians in a psychiatry department conducted a violence risk assessment and selected a level of follow-up care.

Results  Of 410 clinicians who completed the simulation, 60% of psychiatrists were more likely than other types of clinicians to select higher levels of care (inpatient or emergency services) for the standardized virtual patient (odds ratio=2.67, 95% confidence interval=1.67–4.25), even after adjustment for other factors. Virtual actions taken, such as contracting with the patient for safety and discussing hospitalization, elucidated these training differences.

Conclusions  Training backgrounds were important determinants of clinicians’ actions and the dispositions they recommended for a psychiatric patient at high risk of self-harm and harm to others in the educational setting and may suggest the need for further training to standardize and optimize care.

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Table 1Predictors of inpatient level-of-care disposition decision among 358 mental health clinicians evaluating the same Web-based patient simulation
Table Footer Note

a CSAT, computer simulation assessment tool



Goldberg  JF;  Ernst  CL;  Bird  S:  Predicting hospitalization versus discharge of suicidal patients presenting to a psychiatric emergency service.  Psychiatric Services 58:561–565, 2007
[CrossRef] | [PubMed]
Rabinowitz  J;  Massad  A;  Fennig  S:  Factors influencing disposition decisions for patients seen in a psychiatric emergency service.  Psychiatric Services 46:712–718, 1995
Baxter  S;  Chodorkoff  B;  Underhill  R:  Psychiatric emergencies: dispositional determinants and the validity of the decision to admit.  American Journal of Psychiatry 124:1542–1548, 1968
Mendel  WM;  Rapport  S:  Determinants of the decision for psychiatric hospitalization.  Archives of General Psychiatry 20:321–328, 1969
[CrossRef] | [PubMed]
Meyerson  AT;  Moss  JZ;  Belville  R  et al:  Influence of experience on major clinical decisions: training implications.  Archives of General Psychiatry 36:423–427, 1979
[CrossRef] | [PubMed]
George  L;  Durbin  J;  Sheldon  T  et al:  Patient and contextual factors related to the decision to hospitalize patients from emergency psychiatric services.  Psychiatric Services 53:1586–1591, 2002
[CrossRef] | [PubMed]
Way  BB;  Allen  MH;  Mumpower  JL  et al:  Interrater agreement among psychiatrists in psychiatric emergency assessments.  American Journal of Psychiatry 155:1423–1428, 1998
Wynn  R;  Myklebust  LH;  Bratlid  T:  Psychologists and coercion: decisions regarding involuntary psychiatric admission and treatment in a group of Norwegian psychologists.  Nordic Journal of Psychiatry 61:433–437, 2007
[CrossRef] | [PubMed]
Gorrindo  T;  Baer  L;  Sanders  KM  et al:  Web-based simulation in psychiatry residency training: a pilot study.  Academic Psychiatry 35:232–237, 2011
[CrossRef] | [PubMed]
Passmore  K;  Leung  WC:  Defensive practice among psychiatrists: a questionnaire survey.  Postgraduate Medical Journal 78:671–673, 2002
[CrossRef] | [PubMed]
Garvey  KA;  Penn  JV;  Campbell  AL  et al:  Contracting for safety with patients: clinical practice and forensic implications.  Journal of the American Academy of Psychiatry and the Law 37:363–370, 2009
McNiel  DE;  Lam  JN;  Binder  RL:  Relevance of interrater agreement to violence risk assessment.  Journal of Consulting and Clinical Psychology 68:1111–1115, 2000
[CrossRef] | [PubMed]
Schulman  KA;  Berlin  JA;  Harless  W  et al:  The effect of race and sex on physicians’ recommendations for cardiac catheterization.  New England Journal of Medicine 340:618–626, 1999
[CrossRef] | [PubMed]
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