An audit of physical examinations in a Psychiatric Intensive Care Unit

Background: People with severe mental illness are at increased risk of developing serious physical health problems, including metabolic syndrome, cardiac and respiratory diseases.

Aims: To audit the admission physical examinations carried out on patients admitted to a male psychiatric intensive care unit.

Method: A retrospective audit of 100 sets of case notes. After the first 45 case notes had been audited, the results were presented at a clinical meeting and an action plan formulated. A further 55 cases were then audited.

Results: Overall, 70 patients had an admission physical examination and 25 (36%) of these were abnormal. In 11 (16%) cases medical intervention was required, occasionally urgently and in 5 (7%) the abnormalities detected impacted on psychiatric diagnosis or management. In the re-audit there was no significant improvement in the proportion of patients having an admission physical but better documentation as to why one was not done and more patients had had a physical by discharge.

Conclusion: Physical examination on admission is an integral part of patient assessment and may identify underlying physical illness that may require urgent intervention and/or impact on psychiatric diagnosis or management. Clinical audit provides a means of detecting and rectifying absent admission physicals.