This study aims at exploring the attitudes of psychiatrists towards their work as consultants in the emergency room (ER). Considerations and suggestions concerning the use of Internetbased surveys for research purposes are also offered.
A quali-quantitative Internet survey was sent to 288 psychiatrists. The 11-item questionnaire was composed of 8 half-structured questions, 2 multiple-choice questions and 1 open question. Survey Monkey was used to collect responses. Data collection lasted for two weeks. Psychiatric consultation activity in the ER deals with assessing and managing patients with mental health problems in the specific context of urgency/emergency. Results Of the 288 invitations sent by e-mail, 132 questionnaires were returned (response rate: 45.8%); of these, 58 provided useful data since they were answered by psychiatrists who usually practice as consultants in the ER. Fifty-three percent of the responders were women. Mean age was 43.6 years ± 7.4. Forty percent of the consultants said they are called in the ER “more than once a week”, mainly due to “acute clinical failures” (31%), “behavioural emergencies” (22%), “acute clinical onsets” (17%) and “self-harm behaviours” (13.8%). “Social emergencies” were indicated as a rare cause of consultation (1.7%), although they were considered particularly challenging by 36.2% of psychiatrists. A large proportion of psychiatric assessments in the ER (69%) led “to prescribe a therapy and send the patient to the mental health community centre”. Some critical aspects were pointed out, such as: “lack of suitable setting” (50.9%) for meeting the patient, a “trend to delegate to the psychiatrist” (45.5%) by ER personnel, “poor autonomy of the personnel working in the ER” (38.2%) and “poor perceived safety” (30.9%) by the consultant. Notwithstanding, the vast majority of psychiatrists (75.9%) reported that they enjoy their activity as consultants in the ER.
The study points out that the majority (75.9%) of psychiatrists like their job as consultants in the ER, even if referrals are not always appropriate and settings sometimes fail to be suitable. Some relevant critical aspects were also addressed that should provide suggestions for improvement of effectiveness, organization and integration within the general hospital, to reduce waste of resources. Internet is useful and feasible as a research tool, due to low costs and easy logistics, particularly when studying younger subjects, although limited external validity might be a problem that is only partially addressed by adopting mixedmethod strategies of research.