Background The process of medical clearance aims to exclude a general medical condition as an underlying cause for mental and behavioural disorders and involves routine screening with special investigations. Current evidence, however, suggests that clinician gestalt should guide the need for special investigations and that there is no benefit to routine screening. Aim This study aimed to determine the effectiveness of and adherence to the Western Cape (WC) provincial guidelines for routine investigations of adult patients with behavioural disturbances. Setting This study was conducted at Mitchells Plain Hospital in Cape Town, South Africa. Methods This descriptive study was conducted at Mitchells Plain Hospital in Cape Town, South Africa. Data were collected from existing electronic registries over a 6-month period. Adult mental healthcare users were risk stratified into the probability of having a general medical condition and the results of their special investigations were described against their outcome. Results Of the 688 patients included in this study, 66% had abnormal vital signs and of the 312 patients who received special investigations, 56% were abnormal, including 18% who were clinically significantly abnormal. Abnormal special investigations changed the clinical outcome for 3 (<1%) patients. Adherence to the guidelines was reasonable (82%) but non-adherence resulted in unnecessary investigations. Conclusion The results of this study support the existing evidence that clinical assessment and clinician gestalt should guide the need for special investigations and that there is no benefit to routine screening in the emergency centre (EC). The results also demonstrate that non-adherence rarely changed patient outcomes. Contribution This study provides information on the value of routine screening investigations in ECs.

中文翻译：

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对有精神和行为障碍的患者进行常规检查。

背景 体检过程旨在排除一般健康状况作为精神和行为障碍的根本原因，并涉及常规筛查和特殊调查。然而，目前的证据表明，临床医生格式塔应该指导特殊调查的需要，并且常规筛查没有任何好处。目的 本研究旨在确定西开普省 (WC) 省级行为障碍成年患者常规调查指南的有效性和遵守情况。背景 这项研究是在南非开普敦的米切尔斯平原医院进行的。方法 这项描述性研究是在南非开普敦的米切尔斯平原医院进行的。数据是在 6 个月内从现有电子登记处收集的。成年心理保健使用者被风险分层为患有一般健康状况的可能性，并且根据他们的结果描述了他们的特别调查的结果。结果本研究纳入的688例患者中，66%的患者存在生命体征异常；在接受专项检查的312例患者中，56%的患者存在生命体征异常，其中18%的患者存在临床显着异常。异常的特殊检查改变了 3 名（<1%）患者的临床结果。遵守指南是合理的（82%），但不遵守会导致不必要的调查。结论 本研究的结果支持现有证据，即临床评估和临床医生格式塔应指导特殊调查的需要，并且急诊中心 (EC) 的常规筛查没有任何好处。结果还表明，不依从性很少会改变患者的治疗结果。贡献 本研究提供了有关 EC 常规筛查调查价值的信息。