Medical clearance: the routine bloods have no constituency left

Design

scoping review with thematic analysis, four databases from inception to April 2025, plus citation searching and expert consultation

Population

145 publications — 62 original articles covering 34,836 patients and 1,149 health professionals, plus 9 society recommendations

Primary outcome

mapping and appraisal of medical screening practices for adult psychiatric emergency presentations

Effect

eight practice themes identified, laboratory testing the largest (38 of 62); most society recommendations discourage routine laboratory testing

This scoping review mapped everything published on medical screening of adult psychiatric presentations to general emergency departments — 9,128 records screened, 145 publications included, comprising 62 original research articles covering 34,836 patients, 74 non-original publications and 9 society recommendations. It sorted practice into eight themes, of which laboratory testing was much the largest literature (38 of 62 original articles), followed by history taking, vital signs and physical examination.

The finding that changes practice is what the societies say. Most society recommendations discourage routine laboratory testing of psychiatric presentations, and call instead for emergency medicine and psychiatry to agree screening jointly. In other words, the panel of bloods sent reflexively before a psychiatric bed will accept a patient is not something the specialty bodies are asking for — it is local custom, often demanded by the receiving service rather than the referring one.

The honest limitation runs the other way too. None of the nine society recommendations fully met National Academy of Medicine standards for trustworthy guidelines or used GRADE, and the underlying research is mostly retrospective, so 'stop the routine bloods' rests on consensus and weak observational evidence rather than prospective diagnostic accuracy studies. That is enough to stop testing without a reason; it is not enough to stop thinking. History, vital signs and examination remain the screen — the review found these are where the evidence is concentrated, and they are also what a reflexive blood panel tends to displace.

• Order tests from the history and examination, not from a psychiatric presenting complaint
• Renegotiate any local agreement that requires a fixed panel before psychiatric admission — it has no society backing
• Abnormal vital signs, altered consciousness, new psychiatric symptoms in an older adult or a first presentation still warrant investigation
• Document the screening history, observations and examination explicitly; that is what 'medically screened' should mean in the notes
• Recognise the evidence grade — society statements here did not meet GRADE or National Academy of Medicine standards

The statistics, in plain English

A scoping review maps what exists rather than pooling effect sizes, so there is no summary statistic here and no estimate of how often routine testing changes management. The weight of the recommendation comes from consistency across nine society statements, not from measured diagnostic accuracy — and the review specifically notes those statements did not meet accepted standards for trustworthy guideline development. Sixty per cent of the original research was retrospective, a design that tends to underestimate how often unexpected findings matter, because it can only count what was recorded.

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