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ORIGINAL ARTICLE
Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 44-52

Inpatient psychiatric facility exclusionary criteria and the emergency pediatric psychiatric patient


1 Academic Chair and Program Director, Emergency Medicine Residency Program, Merit Health Wesley, Hattiesburg, Mississippi, USA
2 Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
3 Department of Emergency Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA

Correspondence Address:
Veronica Tucci
Academic Chair and Program Director, Emergency Medicine Residency Program, Merit Health Wesley, Hattiesburg, Mississippi
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-5568.209838

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Background: Mental health and behavioral emergencies account for approximately 7% of emergency department visits for pediatric patients. Patients with mental health emergencies requiring inpatient admission pose a particular challenge to emergency clinicians. Patients must be “medically cleared” and criteria for medical clearance vary from hospital to hospital, and can change quickly within hospitals as well. Furthermore, psychiatric hospitals have exclusionary criteria, limiting the patients who can be transferred for psychiatric inpatient care. The objective of this study was to describe the exclusionary criteria and requirements for medical clearance in pediatric patients with mental illness in one large U.S. city. Methods: The exclusionary criteria and required laboratory and ancillary testing of all psychiatric inpatient hospitals accepting pediatric patients in Houston, Texas were catalogued. Results: Seven psychiatric hospitals accept pediatric patients and the requirements for admission vary by hospital. No hospitals accept patients with severe intellectual disabilities or autism or patients unable to independently perform activities of daily living. One hospital accepts pregnant patients. Hospitals have different testing requirements for medical clearance with the majority requiring a complete blood count, creatinine phosphokinase and blood alcohol level. Discussion: We have identified multiple vulnerable populations, including intellectually disabled and patients with autism, who cannot be admitted for necessary psychiatric inpatient treatment and subsequently require emergency department boarding until an alternate treatment plan can be developed. Emergency departments are not an ideal therapeutic environment for patients with psychiatric emergencies, especially patients with intellectual disabilities and autism. Facilities able to provide specialized care are needed. Furthermore, we suggest that national guidelines be developed to standardize an evidence-based medical clearance process. The following core competencies are addressed in this article: Patient care, Systems-based practice.


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