UM Guidelines

Clinical Indications for Admission to Partial Hospital Program

• Admission to Sub-Acute Level of Care[A](1)(2) is judged appropriate as indicated by ALL of the following:
  • Patient has met acute inpatient psychiatric criteria but does not meet continued acute inpatient care criteria
  • Patient requires step-down to sub-acute inpatient level of care with 24 hour supervised psychiatric care as indicated by 1 or more of the following:
    • Behavior is sufficiently unstable as to require immediate professional intervention to protect patient from harming self and others [B](3)(5)(6)
    • Patient is likely to require intermittent 1:1 supervision, constant observation, or frequent checks for safety [B]
    • Patient requires close medical monitoring or skilled care to evaluate and adjust dosage of psychotropic medications and such medical management and dosage adjustment could not safely be conducted in a lower level of care
    • Patient requires a medication taper and re-evaluation in a closely monitored setting.  Previous attempts to taper medications have resulted in behavioral escalations that meet admission criteria for inpatient hospitalization

References

1. Level of care placement. In: Mee-Lee D, Shulman GD, Fishman MJ, Gastfriend DR, Miller MM, Provence SM, editors. ASAM Criteria Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. 3rd ed. Carson City, NV: The Change Companies; 2013:174-306.
2. Matching multidimensional severity and level of function with type and intensity of service. In: Mee-Lee D, Shulman GD, Fishman MJ, Gastfriend DR, Miller MM, Provence SM, editors. ASAM Criteria Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. 3rd ed. Carson City, NV: The Change Companies; 2013:69-104.
3. Gelenberg AJ, et al. Treatment of patients with major depressive disorder. 3rd edition [Internet] American Psychiatric Association. 2010 Oct Accessed at: http://psychiatryonline.org/guidelines.aspx. [accessed 2013 Oct 4] DOI: 10.1176/appi.books.9780890423387.654001.
4. Sudak HS. Suicide. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:2717-31.
5. Baron DA, Dubin WR, Ning A. Other psychiatric emergencies. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:2732-45.
6. Myklebust LH, Sorgaard K, Rotvold K, Wynn R. Factors of importance to involuntary admission. Nordic Journal of Psychiatry 2012;66(3):178-82. DOI: 10.3109/08039488.2011.611252.
7. Kleber HD, et al. Practice guideline for the treatment of patients with substance use disorders. 2nd ed. [Internet] American Psychiatric Association. 2007 Apr Accessed at: http://psychiatryonline.org/guidelines.aspx. [created 2006 May; accessed 2013 Oct 4] DOI: 10.1176/appi.books.9780890423363.141077.
8. Sharfstein SS. Goals of inpatient treatment for psychiatric disorders. Annual Review of Medicine 2009;60:393-403. DOI: 10.1146/annurev.med.60.042607.080257.
9. Seitz DP, et al. Characteristics of older adults hospitalized in acute psychiatric units in ontario: a population-based study. Canadian Journal of Psychiatry 2012;57(9):554-63.
10. Fochtmann LJ, Mojtabai R, Bromet EJ. Other psychotic disorders. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:1605-28.
11. Jacobowski NL, Heckers S, Bobo WV. Delirious mania: detection, diagnosis, and clinical management in the acute setting. Journal of Psychiatric Practice 2013;19(1):15-28. DOI: 10.1097/01.pra.0000426324.67322.06.
12. Kuehn BM. Integrated care key for patients with both addiction and mental illness. Journal of the American Medical Association 2010;303(19):1905-7. DOI: 10.1001/jama.2010.597.
13. Lichtenberg P. The residential care alternative for the acutely psychotic patient. Psychiatric Quarterly 2011;82(4):329-41. DOI: 10.1007/s11126-011-9176-0.
14. Solai LK. Delirium. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:1153-66.
15. Velligan DI, et al. Strategies for addressing adherence problems in patients with serious and persistent mental illness: recommendations from the expert consensus guidelines. Journal of Psychiatric Practice 2010;16(5):306-24. DOI: 10.1097/01.pra.0000388626.98662.a0.
16. Boyer DE, Kane C. Program evaluation of a community crisis stabilization program. Archives of Psychiatric Nursing 2010;24(6):387-96. DOI: 10.1016/j.apnu.2010.03.002.
17. Geller JL. The role of the hospital in the care of the mentally ill. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:4299-314.
18. Psychiatric evaluation of adults. Second edition. American Journal of Psychiatry 2006;163(6 Suppl):3-36. (Reaffirmed 2013 Nov)
19. Service planning and placement. In: Mee-Lee D, Shulman GD, Fishman MJ, Gastfriend DR, Miller MM, Provence SM, editors. ASAM Criteria Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. 3rd ed. Carson City, NV: The Change Companies; 2013:105-26.
20. Sowers WE, Rohland B. American Association of Community Psychiatrists' principles for managing transitions in behavioral health services. Psychiatric Services 2004;55(11):1271-5.
21. Practice guideline for the assessment and treatment of patients with suicidal behaviors. American Journal of Psychiatry 2003;160(11 Suppl):1-60. (Reaffirmed 2013 Nov)

Footnotes

[A] Subacute psychiatric units are generally locked, equipped to restrain or seclude patients if necessary, and staffed by nurses around the clock. Attending physicians typically round at least 5 days per week, and a covering physician is always available to assess patients on site.(1)

[B] Patients with persistent thoughts of suicide, homicide, or serious harm to self or another may need frequent monitoring for progression to planning or intention to act on their thoughts. Such monitoring can be safely conducted in an outpatient level of care if providers and supports are available and the patient can reliably participate in the monitoring process.(4)(21)