Draft Framework For Medical Assessment Of Psychiatric Patients

The Michigan Department of Health and Human Services (MDHHS) and Michigan Health & Hospital Association (MHA) announced recently they are seeking feedback on guidelines designed to standardize the process of evaluating emergency department patients in psychiatric crisis and reduce barriers to accessing inpatient psychiatric services.  The guidelines for the Medical Appropriateness for Psychiatric Admission Guide were developed as part of a larger statewide effort known as Michigan Inpatient Psychiatric Admissions Discussion (MIPAD). The document provides a framework for the medical assessment of individuals who are in psychiatric crisis and present at the emergency department.  “Securing inpatient psychiatric services for individuals presenting in emergency departments has become increasingly complex and time consuming over the last decade,” said Dr. George Mellos, MDHHS’s director of Behavioral Health and Developmental Disabilities Administration. “As part of a growing trend in Michigan and across the nation, psychiatric patients most in need of inpatient services often face the longest wait to transition to an appropriate care setting.”   The trend, commonly referred to as emergency department boarding, occurs for a host of reasons. In Michigan, the MIPAD workgroup identified medical clearance – the clinical process of performing a medical, surgical and/or psychiatric evaluation on an individual presenting in an emergency department – as one of the barriers to timely access to inpatient psychiatric services. Upon further evaluation, the MIPAD workgroup reached the following conclusions:

  • The requirements for the medical clearance process vary significantly from hospital to hospital.
  • Disagreements between emergency department clinicians and admitting providers over whether an inpatient psychiatric unit can provide appropriate and safe care to individuals with co-occurring conditions frequently leads to breakdowns in the admissions process.

To address the medical clearance barrier, MDHHS and MHA convened a multidisciplinary clinical workgroup comprised of nurses, doctors and specialists in emergency medicine, psychiatry, psychology and pediatrics, along with administrative experts in hospital management and state policy officials. The workgroup studied literature and research on medical clearance and its impact on psychiatric care and gathered input from other state experts to develop the draft framework which has been issued.    Feedback is currently being sought on the guide. Once finalized, MDHHS, MHA and the workgroup will work to support the adoption of standardized practices related to medical assessment across emergency departments and hospitals with psychiatric units.  Going forward, MDHHS will work to coordinate these efforts with other statewide activities for addressing behavioral health services and care under the Michigan Psychiatric Care Improvement Project (MPCIP).  Additional information about the Medical Clearance Workgroup and the MPCIP can be found on theMDHHS website.