Examinations of fitness for custody in the emergency department

Background Emergency departments are regularly confronted with examinations of fitness for custody. These examinations should help to prevent damage to people's health while being in custody. However, both guidelines about the extent and the indications of these examinations and appropriate quality indicators are lacking. Objectives Retrospective analysis of the examinations of fitness for custody and elaboration of a standard operating procedure (SOP), which should guarantee a structured examination and appropriate documentation. Methods Retrospective analysis of the examinations of fitness for custody in a very large emergency department in Stuttgart between January 2011 and March 2021. The documentation of the examinations was analyzed regarding the completeness of the following quality indicators: medical history, vital parameters, neurological and physical examination. After conducting a thorough literature research, a SOP which should guarantee a structured examination and an appropriate documentation was elaborated. Results In total, 4567 examinations were analyzed. In 54.26%, a physical examination was documented, while a medical history was documented only in 5.98%. The vital parameters were completely documented in only 9 cases. In all, 80.67% of the patients were considered fit for custody. Discussion The analyzed examinations and their documentation reveal severe deficiencies. It becomes evident that in Germany a systematic evaluation, particularly among clinicians, is still lacking. The developed SOP is based on current literature and provides a structured and feasible approach for examinations of fitness for custody and their documentation.