Patients presenting with psychosis to general hospital emergency departments can present challenges to assessment but it is essential to exclude any organic aetiology.

This study measures compliance with recommendations from the BMJ Best Medical Practise guidelines (1). They recommend that organic causes be investigated as follows:

• All patients undergo full neurological assessment

• All patients undergo basic blood tests

• All patients undergo urine dip and urine drug screening

Retrospective study of 31 inpatients seen in A&E department at the Norfolk and Norwich University Hospital January 2013 – April 2014.

• Clinical case notes were reviewed to identify those with documented psychotic symptoms

• 124 patients identified

• 27 excluded – notes unavailable

• 29 excluded as there was no A&E attendance

• 37 patients excluded as no documented psychotic symptoms.

This left 31 patients to be included

• No patients underwent all investigations recommended

• 71% of patients had a recorded GCS/AVPU score.

• 90% of patients underwent at least one blood test investigation

• 12% of patients underwent urine dip and 0% urine drug screening

• The standard of practice was unacceptable

• All staff should be reminded of the importance of clear documentation in patient notes including any refusal/ un-cooperation of patients to examination or treatment

• Local guidelines/ educational sessions should be developed to review assessment of this patient group

• Clinical staff should be reminded of recommended investigations for patients presenting with altered mental state

1. 1) http://bestpractice.bmj.com/best-practice/monograph/1066/diagnosis/step-by-step.html