Date
of Last Review 3/13/07
SME: Director of Patient Services
Accurate assessment of the patient needs is an important component of determining
the best course of treatment which leads to determining which patients are best
treated at UTHCPC and which are in need of alternative services.
The admission criteria are based on the current guidelines of the Texas Department of Health for inpatient psychiatric services and by the American Academy of Child and Adolescent Psychiatry.
A child patient (over the age of the three years) or adolescent patient (under the age of eighteen years) must meet criteria I, II, III in order to be admitted to UTHCPC.
The patient must meet at least one of the following criteria that can only be treated in a hospital setting:
Criterion |
Description | ||||||||
Danger to self |
The patient demonstrates the danger as follows:
| ||||||||
Danger to others |
The patient demonstrates one of the following:
| ||||||||
Acute onset of psychosis |
The patient exhibits acute onset of psychosis or severe thought disorganization or significant clinical deterioration, making the patient unable to cooperate in treatment and in need of assessment in a safe, therapeutic setting. | ||||||||
Eating disorder |
The patient has a severe eating disorder that requires 24 hours of medical observation, supervision and intervention. | ||||||||
24-hour requirement |
Proposed treatment/therapy requires 24 hours of medical observation, supervision, and intervention. | ||||||||
Severe disorientation |
The patient exhibits severe disorientation to person, place, or time. | ||||||||
Setting requirement |
The patient's evaluation and treatment cannot be carried out safely or effectively in other settings due to severely disruptive physically, psychologically, or sexually abusive behaviors. | ||||||||
Medication/ |
The patient requires medication therapy or complex diagnostic evaluation where his/her level of functioning precludes cooperation with the treatment regimen. | ||||||||
Legal system |
The patient is involved in the legal system and manifests psychiatric symptoms which lead the court to order him/her to undergo a comprehensive assessment in a hospital setting in order to clarify the diagnosis and treatment needs. |
The patient must meet criteria II in order to be admitted to UTHCPC:
Criterion |
Description |
1 |
The patient has a valid DSM IV TR Plus, Axis I diagnosis as the principal admitting diagnosis. |
2 |
Outpatient therapy has been attempted and has failed. |
3 |
The psychiatrist has documented reasons why a less restrictive place of service would be inappropriate. |
Criteria III |
The patient must meet criteria III in order to be admitted to UTHCPC: |
Criterion |
Description |
1 |
Proper treatment of the patient's psychiatric condition requires services on an inpatient basis under the direction of a psychiatrist provided in the least restrictive environment available. |
2 |
Ambulatory care resources available in the community do not meet the patient's needs. |
For continued stay, the patient must continue to meet the following:
Criterion |
Description |
1 |
One of the criteria listed under Criteria I is still valid. |
2 |
The treatment plans require services on an inpatient basis. |
3 |
Providing the treatment to the patient is reasonably expected to improve the patient's condition or prevent further regression. |
4 |
The treatment is being provided in the least restrictive environment available. |
5 |
Initial goals/discharge have been formulated and action toward implementation is taken. |
6 |
The implementation of individualized plans has started. |
The following represent indication for discharge:
 | Documented evidence of no further improvement in cases of chronic illness |
| Documented evidence of no further improvement in cases of acute illness |
| Arranged adequate alternative placement |
| Documentation that the patient is no longer suicidal or a threat to others |
| 24-48 hour stable remission as reference for each documented discharge criterion |
Children and adolescents that are admitted under the exclusion criteria will be transferred or discharged to a more appropriate setting after an evaluation.
The following categories of patients are excluded from admission:
Category |
Description |
1 |
Children and adolescents with a primary diagnosis of mental retardation |
2 |
Children and adolescents with substance abuse problems and no other psychiatric disorder |
3 |
Children and adolescents whose evaluation and/or treatment might be achieved in other less restrictive settings Example: As an outpatient, day program, or school settings |
4 |
Children and adolescents who have been evaluated and are awaiting long term placement in foster care or residential treatment settings |
5 |
Patients whose physical infirmities outweigh their psychiatric problems and who might better be treated in a medical facility Reference: See Physical infirmities. |
Physical infirmities that are exclusionary are those that outweigh patient psychiatric problems and exceed the clinical capability of the hospital.
These physical infirmities are defined by UTHCPC as:
| Medically fragile patients currently requiring nursing home care for serious and/or multiple Axis III disorders, including significant alterations of ADL's |
| Decubiti |
| Unresolved cellulitus requiring ongoing treatment |
| Sleep apnea |
| Ongoing IV therapy, Hep locks, or Subclavian line |
| Suctioning |
| Continuous oxygen or support equipment (CPAPs, Bi-PAPs, O2 Concentrator, etc.) |
| O2 saturation level below 99% |
| Indwelling tubing (e.g., foley catheter, feeding tubes, etc.) |
| Tracheostomy (requiring maintenance, cannula in place) |
| Active TB |
| Anyone requiring isolation |
| Special medical equipment that requires observation and upkeep |
| Patient's condition requires dirty utility room support |
| Patients requiring physical therapy or rehabilitative services/therapies |
| Post-op stability not demonstrated through labs, vital signs over a 48-hour period |
| Complex high blood pressure-hypertensive patients not stabilized to a diastolic less than 110, maintained over at least a 24-hour period |
| Brittle diabetics that run unstable blood sugars |
| Insulin dependent diabetes with a sugar over 400 within the last 2 hours |
| Temperatures over 101° |
| Patients requiring peritoneal or renal dialysis treatments |
| Open wounds and/or wounds requiring sterile equipment to manage |
| White blood count > 15,000 |
| CPK over 1500 or CPK greater than 1000 with elevated temperature and muscular rigidity |
| Patients who have overdosed and are in ICU not fully conscious and without stable vital signs for 2 hours post ICU discharge following the overdose |
| Anyone with cardiovascular problems who is symptomatic (chest pains, shortness of breath, unstable arrhythmia, and chest x-ray noting pulmonary edema) |
| Delirium secondary to a known medical condition other than a substance related condition |
| Any medical condition requiring daily laboratory monitoring |
| Patient is being transferred for substance abuse de-tox (exception alcohol) |
Note: The above may be waived, where appropriate, only by the admitting attending physician.
Related to regulatory standards
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