Date
of Last Review 3/13/07
SME: Director of Patient Services
Harris County patients who are 18 years or older (or legally emancipated), in
need of inpatient psychiatric services, and meet the approved UTHCPC admission
criteria are eligible for admission to UTHCPC for psychiatric evaluation and
treatment.
An adult patient has to meet one of the following criteria to be approved for admission:
Criterion |
Description | ||||||||||||||
1 |
Recent (within 72 hours) suicide attempts or documentation of suicide ideation requiring suicide precautions | ||||||||||||||
2 |
Assaultive behavior, or documentation of self-mutilative behavior as a result of a psychiatric disorder | ||||||||||||||
3 |
Major depression that must have four of the following symptoms:
| ||||||||||||||
4 |
Acute onset or acute exacerbation of hallucinations, delusions, illusions, that threatens the patient's well-being | ||||||||||||||
5 |
Substance use related symptoms/behavior in one of the following:
| ||||||||||||||
6 |
Inability to comply with prescribed outpatient psychiatric health regimens when s/he has the following:
| ||||||||||||||
7 |
Potential hazard to his/her health or life that is due to concurrent psychiatric illness and inability to comply with prescribed medical health regimens Example: Insulin-dependent diabetes | ||||||||||||||
8 |
Acute onset of inability to care for self or attend activities of daily living and reasonable expectation that resumption of self-responsibility will occur following the appropriate treatment | ||||||||||||||
9 |
Manic state of sufficient severity that makes treating him/her more difficult in a less restrictive setting due to hyperactivity, lack of sleep, poor judgement Poor judgment : Spending sprees, sexual indiscretions, or grossly psychotic behavior or thoughts | ||||||||||||||
10 |
Evidence of symptoms and/or behavior or verbalizations that reflect significant risk or potential danger to self, others or property |
For continued stay, the patient must continue to meet one of the admission criteria listed previously and the treatment/therapy regimen and must include all of the following:
Criterion |
Description |
1 |
Implementation of individualized treatment plan for the client's psychiatric condition requires services on an inpatient basis. |
2 |
Provision of services can reasonably be expected to improve the client's condition or prevent further regression so that a lesser level of care can be implemented. |
3 |
Treatment/therapy is being provided in the least restrictive environment available. |
4 |
Initial goals/discharge plans have been formulated and actions have been taken toward implementation. |
5 |
The attending physician and other Treatment Team members must consistently document concise and legible progress notes supporting the criteria met and progress toward meeting goals. |
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 patient is no longer suicidal or a threat to others |
| Stable remission of 24-48 hours as reference for each documented discharge criterion |
This table describes adult persons excluded from admission:
Criteria |
Description |
1 |
Persons who appear to require longer care than afforded at UTHCPC |
2 |
Persons with unusually complex aftercare problems which might prolong his/her stay in the hospital |
3 |
Persons whose physical infirmities outweigh his/her psychiatric problems and who might better be treated in a medical facility (See "Physical Infirmities" for exclusion criteria) |
4 |
Persons with a primary diagnosis of mental retardation |
5 |
Persons with active criminal charges, currently residing in jail (unless ordered by the court) |
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 Pulmonary 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 |
| 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 |
| Post overdose patients being released prior to meeting poison control guidelines. |
| 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.
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