Inpatient Clinical Pathway for Children with
Behavioral Health Discharge Disposition
- Medical Team Assessment
- History and physical examination, Medical Clearance evaluation, psychiatric clearance as clinically indicated
- Initiate BH Disposition Pathway Order Set
- Suicide Prevention Bundle, as clinically indicated
- Level of safety observation, as clinically indicated
- Consult at the time of admission
- Unit Social Worker – All children
- Behavioral Health Integrated Program (BHIP), as clinically indicated
- 24-48 hours after Social Work/BHIP consult, schedule family meeting
- Include medical team/BHIP/unit Social Work
- Discuss discharge care options using mutual decision making
- Review Medical Clearance evaluation, timing
Level of Discharge Care Recommendations
As determined by Social Work and/or BHIP
As determined by Social Work and/or BHIP
Low Acuity Discharge Care
- Outpatient services
- Crisis Mobile Intensive Services
- Intensive Outpatient
- Partial hospitalization
- Blended case management
- Behavioral health rehabilitation
- Family Based Services
High Acuity Discharge Care
- Acute inpatient hospitalization
- Crisis Stabilization Unit
- Psychiatry completes 201/302
- Consent for treatment/transfer
Initiate Discharge Process
- Medical team confirms medical clearance and medical discharge plan
- Update Medical Clearance Order
- Social Work/BHIP confirms BH Discharge Care Plan
- Centralized Disposition team plans for discharge
- Medical Clearance completed
- Please document the following:
- Patient is medically cleared, awaiting BH disposition planning
Low Acuity Discharge Actions
- Medical Team
- Schedule PCP follow-up appointment for patient
- If CHOP PCP, Epic note to PCP
- Discharge patient
- Nursing
- Prepare and review BH discharge instructions with patient/family
- Obtain discharge consent
- Return medications and/or belongings
- Unit Social Work
- Meets with patient/family
- Provides education for discharge planning
- Provides outpatient BH resources or refers case to Social Work BH disposition coordinator, as appropriate
- Social Work Coordinator
- Schedule BH outpatient appointment, as requested by Medical
- Team/BHIP
- Review with patient/family
- BH appointment time, location
- Provide list of resources at request of BHIP
- Re-contacts patient/family after appointment
- Additional resources, if necessary
Intermediate Acuity Discharge Actions
- Medical Team
- Schedule PCP follow-up appointment for patient
- If CHOP PCP, Epic note to PCP
- Discharge patient
- Nursing
- Prepare and review BH discharge instructions with patient/family
- Obtain discharge consent
- Return medications and/or belongings
- Unit Social Work
- Meets with patient/family
- Provides education for discharge planning
- Refers case to Social Work BH disposition coordinator
- Social Work Coordinator
- Refer patient to recommended BH program
- Complete referral packet
- Assures insurance pre-authorization
- Secure intake date for patient/family
- Follow-up call day after discharge and day after scheduled appointment
- Confirm patient/family BH plan
- Additional resources, if necessary
- Medical Team
- Document medical clearance/stability
- Weekdays
- Refers case to unit Social Work
- Weekends
- Refers case to on-call Social Work
- Nursing
- Confirm original 201/302 in chart
- Inpatient clerk to copy chart and place original 201/302 with the copied chart
- If notified by Social Work, complete RN to RN handoff through transport
- In discharge instructions, include interagency transfer note
- Complete transport checklist
- Unit Social Work
- Meets with patient/family to confirm discharge plan
- Provides education for discharge planning
- Refers case to Social Work BH disposition coordinator
- Care coordination between primary care team and BH disposition team
- Social Work Coordinator
- Review options for placement with patient/family
- Completes insurance pre-authorization
- Confirm 201/302 completed and in physical chart
- 201 copied into Media tab
- Fax psychiatry assessment to appropriate facilities
- Escalation Plan
(If needed due to placement difficulty) - Facility accepts patient for transfer
- Patient/family and medical team informed
- SW initiates Ambulance Transport documentation
- Transport department completes transfer
- *Transfers other than acute inpatient psychiatric placement are completed by family members, children youth services, or community agencies
Posted: May 2020
Revised: May 2023
Editors: Clinical Pathways Team
Evidence
- Common and Costly Hospitalizations for Pediatric Mental Health Disorders
- Predictors for Readmission into Children’s Inpatient Mental Health Treatment
- Postacute Care after Pediatric Hospitalizations for a Primary Mental Health Condition
- Psychiatric Disorders and Trends in Resource Use in Pediatric Hospitals
CHOP Programs