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Behavioral Health Discharge Disposition — Medical Clearance — Clinical Pathway: Inpatient

Behavioral Health Discharge Disposition Clinical Pathway — Inpatient

Medical Clearance

Decision to medically clear a patient is based on identifying and addressing all active medical concerns. Medical clearance planning begins at the start of care.

Considerations for medical clearance:

  • Ruling out active medical processes that are driving current behavioral health presentation
  • Estimate timeline for discharge
  • Additional labs/imaging
  • Vital signs
  • Taking PO
  • Ambulatory
  • Medical device
  • Medical follow-up

Behavioral Health Considerations for Medical Clearance Evaluation

History and Physical
  • Screen for active BH complaints and symptoms:
    • Depression/anxiety that is impacting medical care or ability to function
    • Suicidal/homicidal ideation
    • Auditory/visual hallucinations, delusions or other evidence of psychosis
    • Behaviors leading to unsafe environment (risky/impulsive behaviors)
  • Psychiatric diagnoses
  • Previous psychiatric hospitalizations
  • Previous history of suicide attempts or self-injurious behaviors
Mental Status Exam
  • Appearance
  • Orientation
    • Person, place, time, and situation
  • Behavior
    • Activity level, age appropriateness
  • Affect (observed)
  • Mood (reported)
Labs
  • Standard for all BH patients:
  • Urine
    • Drug Screen
    • Pregnancy test post menarchal
  • EKG
  • As clinically indicated:
  • CBC
  • TSH, reflex T4
  • Labs directly related to current clinical presentation
    • (i.e., overdose — medication levels, malnutrition/metabolic labs, etc.)
  • MRI Brain/LP/EEG (if applicable)
Therapies/Medications
  • Current Prescriptions
    • Psychiatric medications, seizure medications
  • Current outpatient therapy/psychiatry providers
Other Risk and Protective Factors
  • CSSRS
  • History of:
    • Psychiatric hospitalizations
    • Suicide attempts
    • Self-injurious behaviors
    • Aggressive behaviors
    • Trauma/abuse
  • Family history of suicides/severe mental health condition leading to hospitalization
  • Other risk factors:
    • No current mental health providers
    • Unstable housing/psychosocial situation
    • Access to guns/weapons/medications
  • Protective factor:
    • In treatment and good rapport with treatment providers
    • Supportive caregivers/family
    • Engaged in activities/school
    • Pets

 

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