Like the Eye of the Tiger: Inpatient Psychiatric Facility Exclusionary Criteria and Its "Knockout" of the Emergency Psychiatric Patient
Over 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in the ED but frequently require admission to an inpatient psychiatric unit or institution for longer term treatment and management. To facilitate this...
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Published in | Journal of emergencies, trauma and shock Vol. 10; no. 4; pp. 189 - 193 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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Medknow Publications and Media Pvt. Ltd
01.10.2017
Medknow Publications & Media Pvt. Ltd Medknow Publications & Media Pvt Ltd Wolters Kluwer Medknow Publications |
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Abstract | Over 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in the ED but frequently require admission to an inpatient psychiatric unit or institution for longer term treatment and management. To facilitate this process, an emergency physician (EP) must first "medically clear" the patient as stable for transfer. At present, there is no interdisciplinary consensus regarding the necessary elements of the medical clearance or stability assessment process. In addition to satisfy the vague requirement for medical clearance, the EP must abide by the rules of the inpatient facilities before his/her patient is accepted.
This manuscript summarizes the admission exclusionary criteria of inpatient psychiatric units in the Houston-Galveston metro area.
we pooled the exclusionary criteria of all the facilities patients with mental illness can be sent to in the Houston-Galveston metropolitan area, and divided those criteria by categories.
Pooled exclusionary criteria congregate into 1. preexisting or current medical condition and capabilities (e.g. hypertensive urgency, pregnancy, acute alcohol intoxication), 2. exclusionary criteria related to administrative burdens that may impact staffing or require advanced equipment/training e.g. autism spectrum disorders, intellectual disabilities, respiratory isolation or daily hemodialysis, 3. laboratory and ancillary testing required by inpatient facilities before acceptance of the patient.
Of the inpatient units in the Houston-Galveston area, facilities lack a unified staffing model, ancillary services, but the various challenges (e.g., limited staffing and ancillary services) and different skills offered (e.g., geriatric care) are reflected in exclusionary criteria in a partially overlapping, but not fully uniform, way. The variation in number and kinds of exclusionary criteria further complicate the admission process and often serve as a bottleneck in the securing an inpatient bed. |
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AbstractList | Over 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in the ED but frequently require admission to an inpatient psychiatric unit or institution for longer term treatment and management. To facilitate this process, an emergency physician (EP) must first "medically clear" the patient as stable for transfer. At present, there is no interdisciplinary consensus regarding the necessary elements of the medical clearance or stability assessment process. In addition to satisfy the vague requirement for medical clearance, the EP must abide by the rules of the inpatient facilities before his/her patient is accepted.
This manuscript summarizes the admission exclusionary criteria of inpatient psychiatric units in the Houston-Galveston metro area.
we pooled the exclusionary criteria of all the facilities patients with mental illness can be sent to in the Houston-Galveston metropolitan area, and divided those criteria by categories.
Pooled exclusionary criteria congregate into 1. preexisting or current medical condition and capabilities (e.g. hypertensive urgency, pregnancy, acute alcohol intoxication), 2. exclusionary criteria related to administrative burdens that may impact staffing or require advanced equipment/training e.g. autism spectrum disorders, intellectual disabilities, respiratory isolation or daily hemodialysis, 3. laboratory and ancillary testing required by inpatient facilities before acceptance of the patient.
Of the inpatient units in the Houston-Galveston area, facilities lack a unified staffing model, ancillary services, but the various challenges (e.g., limited staffing and ancillary services) and different skills offered (e.g., geriatric care) are reflected in exclusionary criteria in a partially overlapping, but not fully uniform, way. The variation in number and kinds of exclusionary criteria further complicate the admission process and often serve as a bottleneck in the securing an inpatient bed. Context: Over 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in the ED but frequently require admission to an inpatient psychiatric unit or institution for longer term treatment and management. To facilitate this process, an emergency physician (EP) must first "medically clear" the patient as stable for transfer. At present, there is no interdisciplinary consensus regarding the necessary elements of the medical clearance or stability assessment process. In addition to satisfy the vague requirement for medical clearance, the EP must abide by the rules of the inpatient facilities before his/her patient is accepted. Settings and Design: This manuscript summarizes the admission exclusionary criteria of inpatient psychiatric units in the Houston-Galveston metro area. Subjects and Methods: we pooled the exclusionary criteria of all the facilities patients with mental illness can be sent to in the Houston-Galveston metropolitan area, and divided those criteria by categories. Results: Pooled exclusionary criteria congregate into 1. preexisting or current medical condition and capabilities (e.g. hypertensive urgency, pregnancy, acute alcohol intoxication), 2. exclusionary criteria related to administrative burdens that may impact staffing or require advanced equipment/training e.g. autism spectrum disorders, intellectual disabilities, respiratory isolation or daily hemodialysis, 3. laboratory and ancillary testing required by inpatient facilities before acceptance of the patient. Conclusions: Of the inpatient units in the Houston-Galveston area, facilities lack a unified staffing model, ancillary services, but the various challenges (e.g., limited staffing and ancillary services) and different skills offered (e.g., geriatric care) are reflected in exclusionary criteria in a partially overlapping, but not fully uniform, way. The variation in number and kinds of exclusionary criteria further complicate the admission process and often serve as a bottleneck in the securing an inpatient bed. CONTEXTOver 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in the ED but frequently require admission to an inpatient psychiatric unit or institution for longer term treatment and management. To facilitate this process, an emergency physician (EP) must first "medically clear" the patient as stable for transfer. At present, there is no interdisciplinary consensus regarding the necessary elements of the medical clearance or stability assessment process. In addition to satisfy the vague requirement for medical clearance, the EP must abide by the rules of the inpatient facilities before his/her patient is accepted. SETTINGS AND DESIGNThis manuscript summarizes the admission exclusionary criteria of inpatient psychiatric units in the Houston-Galveston metro area. SUBJECTS AND METHODSwe pooled the exclusionary criteria of all the facilities patients with mental illness can be sent to in the Houston-Galveston metropolitan area, and divided those criteria by categories. RESULTSPooled exclusionary criteria congregate into 1. preexisting or current medical condition and capabilities (e.g. hypertensive urgency, pregnancy, acute alcohol intoxication), 2. exclusionary criteria related to administrative burdens that may impact staffing or require advanced equipment/training e.g. autism spectrum disorders, intellectual disabilities, respiratory isolation or daily hemodialysis, 3. laboratory and ancillary testing required by inpatient facilities before acceptance of the patient. CONCLUSIONSOf the inpatient units in the Houston-Galveston area, facilities lack a unified staffing model, ancillary services, but the various challenges (e.g., limited staffing and ancillary services) and different skills offered (e.g., geriatric care) are reflected in exclusionary criteria in a partially overlapping, but not fully uniform, way. The variation in number and kinds of exclusionary criteria further complicate the admission process and often serve as a bottleneck in the securing an inpatient bed. |
Audience | Academic |
Author | Shah, Asim Matorin, Anu Moukaddam, Nidal Tucci, Veronica Liu, John |
AuthorAffiliation | 1 Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA 2 Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, Texas, USA |
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Author_xml | – sequence: 1 givenname: Veronica surname: Tucci fullname: Tucci, Veronica organization: Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA – sequence: 2 givenname: John surname: Liu fullname: Liu, John organization: Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA – sequence: 3 givenname: Anu surname: Matorin fullname: Matorin, Anu organization: Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, Texas, USA – sequence: 4 givenname: Asim surname: Shah fullname: Shah, Asim organization: Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, Texas, USA – sequence: 5 givenname: Nidal surname: Moukaddam fullname: Moukaddam, Nidal organization: Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, Texas, USA |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29097857$$D View this record in MEDLINE/PubMed |
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Keywords | medical clearance and stability examination inpatient psychiatric exclusionary criteria Behavioral emergencies psychiatric emergencies |
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References | Simon (key-10.4103/0974-2700.216523-3) 2014 Corl (key-10.4103/0974-2700.216523-12) 2008 Kirby (key-10.4103/0974-2700.216523-9) 1988 key-10.4103/0974-2700.216523-10 Olshaker (key-10.4103/0974-2700.216523-14) 1997 American (key-10.4103/0974-2700.216523-6) 2011 Parmar (key-10.4103/0974-2700.216523-15) 2012 key-10.4103/0974-2700.216523-5 key-10.4103/0974-2700.216523-2 Sood (key-10.4103/0974-2700.216523-4) 2009 key-10.4103/0974-2700.216523-1 Broderick (key-10.4103/0974-2700.216523-11) 2002 Zeller (key-10.4103/0974-2700.216523-8) 2014 Lukens (key-10.4103/0974-2700.216523-13) 2006 key-10.4103/0974-2700.216523-7 |
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Snippet | Over 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in the ED... Context: Over 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized... CONTEXTOver 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in... |
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SubjectTerms | Behavioral emergencies Behavioral sciences Emergency medical care Emergency medical services Emergency services Evaluation Hospitals inpatient psychiatric exclusionary criteria Intellectual disabilities Laboratories Management Medical care quality medical clearance and stability examination Medical screening Medicine Mental disorders Mental health Mental health care Original Patients Physicians psychiatric emergencies Psychiatry Trends Workforce planning |
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Title | Like the Eye of the Tiger: Inpatient Psychiatric Facility Exclusionary Criteria and Its "Knockout" of the Emergency Psychiatric Patient |
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