SHM Converge Scientific Abstract ePoster Gallery-Reassessment Rates of Patients Evaluated by Psychiatry for Decision Making Capacity

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This retrospective study examined how often hospitalized patients who received a formal psychiatry decision-making capacity assessment (DCA) were reassessed during the same hospitalization, and whether their capacity status changed.<br /><br />The authors reviewed electronic medical records from a single tertiary academic hospital between March 2018 and March 2021, identifying 299 patients who had an initial psychiatry DCA note. Reassessment was defined as any later physician documentation mentioning the patient’s capacity. The study also considered patient demographics, diagnoses, location of initial assessment, and discharge disposition.<br /><br />Key findings:<br />- 63% of patients were reassessed during hospitalization.<br />- Reassessment was much more common among patients who initially lacked decision-making capacity (81%) than among those who initially had capacity (24%).<br />- Among patients who initially lacked capacity and were reassessed, 41% later gained capacity, while 53% still lacked capacity.<br />- Among patients who initially had capacity and were reassessed, 4% lost capacity, while 68% maintained capacity.<br />- The difference in reassessment rates between patients who lacked capacity and those who had capacity was statistically significant.<br /><br />The authors conclude that many patients who initially lack capacity may not be reassessed before discharge, even though capacity is intended to be dynamic and decision-specific. This raises concern that clinicians may be applying the concept of decisional capacity inconsistently or not in line with its intended use.<br /><br />Limitations included reliance on documentation quality, review of only psychiatry-led assessments, and inability to capture undocumented verbal reassessments. Future research should examine which diagnoses are associated with failure to reassess and what outcomes occur for patients discharged without capacity reassessment.

Asset Subtitle

Jade R. Samanta

Meta Tag

Author List Akshay Mehta, Jade R. Samanta, Kimbell Kornu, Kyle Karches, Logan Dorsey, Paula Buchanan, Saida Kent

Category Research

Concept Decisional Capacity

Concept Capacity Assessment

Concept Reassessment

Concept Capacity Status

Concept Hospitalized Patient

Distinguished Non-Finalist

Presenter Organization St. Louis University Medical School

Presenting Author Jade R. Samanta

Track Other

Keywords

decision-making capacity

psychiatry assessment

hospitalized patients

capacity reassessment

retrospective study

capacity change

electronic medical records

inpatient psychiatry

discharge disposition

clinical documentation

Decisional Capacity

Capacity Assessment

Reassessment

Capacity Status

Hospitalized Patient