Quality improvement of psychiatric care: challenges of emergency psychiatry

Objective: The provision of excellent patient care is a goal that physicians would like to achieve in caring for all patients, all of the time. Until recently, clinical excellence had not been defined, and the extent to which this recently published definition applies to the care of patients with psychiatric illness is not known. This article sets out to consider how the paradigm for clinical excellence applies to the field of psychiatry.

Data Sources: PubMed, Ovid MEDLINE, and PsycINFO were searched (1962 through December 2010) combining the keywords psychiatry (or psychiatrist) and clinical excellence, limiting the output to English-language case reports. In subsequent searches, the term clinical excellence was replaced by each of the components of the definition: communication and interpersonal skills, professionalism and humanism, diagnostic acumen, skillful negotiation of the health care system, knowledge, scholarly approach to clinical practice, exhibiting a passion for patient care, explicitly modeling mastery to medical trainees, and collaborating with investigators to advance science and discovery.

Study Selection: The search yielded 218 case reports. All of the case reports were reviewed, and a consensus was reached on the 8 exemplars and 1 teaching model to be presented in the article. Careful consideration was given as to whether any aspects of the framework for clinical excellence were missing or not applicable for psychiatry.

Results: Every case report reviewed touched on 1 or more of the domains of clinical excellence. None of the case reports uncovered new aspects of clinical excellence that were not described in the existing definition.

Conclusion: This review of the case reports published in psychiatry reveals that the definition of clinical excellence described in this article may be highly applicable to those caring for patients with psychiatric illness.