For Physicians
This page contains information regarding admission criteria as
well as referring patients to Enloe Behavioral Health for assessments.
Admission Criteria
DEFINITION:
Inpatient: Twenty-four hour hospital care for treatment of a psychiatric
diagnosis.
POLICY:
Admission to the Psychiatric Program is indicated for patients
above the age of 18 who have one or more DSM IV (Diagnostic and
Statistical Manual of Mental Disorders) diagnoses.
PROCEDURE:
Admission Criteria
Admission to the Psychiatric Program is indicated for patients
above the age of 18 who have one or more DSM IV diagnoses and, in
addition, meet the severity of illness and intensity of service
criteria (at least one from each) listed here. Admission criteria
is applied uniformly to both Medicare and non-Medicare patients.
Severity of Illness
- Suicide attempts;
- Suicidal ideation (e.g. depression with feelings of hopelessness
and worthlessness);
- Self-mutilative behavior;
- Homicidal ideation with poor impulse control;
- Assaultive behavior;
- Destructive behavior (to property);
- Psychiatric symptoms (e.g., hallucinations, delusions,
panic reaction, anxiety, agitation, depression) severe enough
to cause disordered, bizarre behavior (e.g., catatonia, mania,
incoherence, autism) or psychomotor retardation resulting in significant
interference with activities of daily living.
Other Conditions May Be Present:
- A recent weight loss/gain refractory to aggressive outpatient
or partial hospitalization therapy;
- Mental disorder refractory to a thoroughly documented effort
at aggressive outpatient or partial hospitalization (e.g. recurrent
psychosis not responsive to outpatient treatment, severe depression
or failing to respond to twenty-one days of outpatient drug therapy);
- Toxic effects of therapeutic psychotropic drugs;
- Introduction of, withdrawal from or change or dose of psychotropic
medication(s), in cases in which there is strong reason to believe
that potentially serious side effects are likely to occur (e.g.
due to high doses and/or concomitant cardiac disease known to
be sensitive to the drugs in question).
Intensity of Service
Treatments:
- Continuous observation and control of behavior to protect self,
others and/or property (e.g., isolation, restraint and other suicide/homicide
precautions).
- Comprehensive multi-modal therapies plan requiring close medical
supervision and coordination due to complexity and/or severity
of the patient's sign and symptoms.
- Psychoactive medications that require (at least daily) close
and continuous skilled medical observation due to side effects
of psychoactive medications (e.g., hypotension, arrhythmia) or
significant increases, decreases or changes of psychoactive medication(s)
requiring close and continuous skilled medical supervision.
Exclusion Criteria
Each case is evaluated on an individual basis by the program leaders.
- Patients with a substantiated diagnosis of dementia with no
acute behavioral change or no known psychiatric disorder and no
expectation for a positive response to treatment.
- Patients with life-threatening acute medical or surgical illnesses
will not be accepted.
- Patients with terminal diseases without a treatable psychiatric
disorder will be referred to an appropriate hospice facility.
- Patients who seek readmission but are determined to be inappropriate
for the program because:
- They have received maximum benefit during previous hospitalization;
- They have refused to participate in the treatment program
or refused to follow through on treatment recommendations.
- Patients who are bedfast or who cannot participate in the treatment
program due to physical limitations.
- Patients with complex medical/surgical procedures, preventing
their participation in the active treatment program.
- Patients with a primary AXIS II disorder (personality disorders).
- Patients with a primary substance use disorder.
Examples of appropriate and inappropriate reasons/situations for
admission
Appropriate
- Suicide attempt or suicidal risk.
- Risk of violence or dangerous assaultive behavior or other acutely
uncontrolled behavior.
- Severely impaired social, family, educational, vocational, or
developmental functioning or severely disordered behavior. The
impairments leading to hospitalization should be acute and inconsistent
with the patient's usual behavior.
- Inability to function outside an acute inpatient facility due
to:
- Significant impaired reality testing or thought/mood disorder
(i.e., hallucinations, delusions, depression, catatonia, mania,
autism, etc.);
- Agitated or psychomotor retardation resulting in significant
interference with activities of daily living;
- Severely disrupted environment that is contributing to the
patient's psychiatric disorder, making outpatient treatment
impossible.
- Reinstitution of a drug regime for a high-risk patient (i.e.,
a patient who has previously shown a severe idiosyncratic reaction
to drugs or multiple system involvement with concurrent drug therapies)
and/or a patient with a co-morbid condition, which will require
close and continuous skilled medical observation and supervision.
Inappropriate
- Psychological testing only.
- Unofficial diagnoses ("emotional upset", "nervous breakdown").
- Pending partial hospitalization or "halfway" house.
- Socio-economic, humanitarian admissions.
- Education and/or assistance in normal development processes
(special education for mentally retarded, residential treatment
programs).
- Admissions for the purpose of weight loss or cessation of smoking.
- Admissions for lifestyle or behavioral changes, for example,
assertiveness training, consciousness raising, vocational or religious
counseling, socialization activities of an educational nature
without a concurrent diagnosis of mental illness. This includes
uncomplicated oppositional and conduct disorders.
- Custodial care/residential care.
- Marital conflicts.
- Pending criminal charges or disposition and/institutionalization
in lieu of detention or correctional process.
- Co-dependency.
- Dysthymic disorder without acute exacerbation.
- Repeated admissions without evidence of improvement or change.
- Admissions for participation in a drug study, clinical investigative
or experimental programs or educational programs.
- Admissions for the primary purpose of initiating or re-instituting
a drug regime that could be performed on an outpatient basis.
Information about Assessments
Doctors who would like to refer a patient to our facility, should
call 530.332.5250. Please be prepared to provide basic demographic
information about the person being referred, including name, address,
social security number, birth date, insurance provider, H&P
and a list of medications. Physicians will need to explicitly
state whether we may contact them about the referral if necessary.
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