NUBE 2025

Psychiatric assessment relies heavily on history; it is important for accurate assessment to have reliable information about a patient's past. Many times patients are unable or unwilling to provide such information themselves. Even when they do supply information, it may be incomplete or of questionable authenticity. This happens often enough to consider obtaining collateral information to get what is necessary to develop a diagnosis and treatment plan. Without such information errors may be made, with possible serious consequences. In emergency room assessments, often a decision must be made about potential dangerousness to self or others and the need for hospitalization. 

Current electronic medical records have embedded many tools to assist clinicians in providing care. Records of encounters within the institution can be easily searched. Some systems, such as Epic, have a function (in Epic's case, CareEverywhere) which can display records from other institutions. Other online sources exist, such as Prescription Drug Monitoring Programs, criminal justice docket sheets, general search engines and social media sites. Patients' insurers are also helpful sources of data, as are calls to pharmacies (often mandated by medication reconciliation requirements.) Phone calls to emergency contacts and others in a patient's life can yield vital historical and current data—whether patients must consent to such calls is debatable, and often waived if evaluation is truly emergent and care is taken not to release any information save that the patient is being evaluated.

Many laws and practices have weighed in to protect the privacy necessary for appropriate medical care, especially psychiatric and substance abuse services. In the US this is done notably by the Health Information Portability and Accountability Act (HIPAA) and Consolidated Federal Regulations Title 42 (42CFRPart 2) as well as applicable state laws. There is some confusion, as well as reasonable differences of opinion, concerning the balance between privacy and clinical imperatives.

We will present our experiences and informed opinions on the utility, bordering on necessity, of obtaining collateral information on nearly every patient assessed in an emergency setting. Legal and ethical concerns will be highlighted. Methods for doing such searches will be reviewed, as well as management of phone calls to other contacts. We will seek participation from our attendees on their use of collateral information in decision-making and work toward development of best practices for assessment.

Learning Objectives:

Describe the value added to assessment by including collateral information.

List applicable legal and ethical considerations in contacting collateral sources.

Demonstrate familiarity with searches within electronic health records and online.