How to Make a Referral for Inpatient Psychiatry Admission

Referring physicians can follow the instructions outlined below to refer a patient for psychiatric admission:

  1. If at University Hospitals Cleveland Medical Center, contact the Psychiatry Consultation-Liaison (CL) service via pager at 30164 to request a consult. If at another UH system hospital, contact the covering psychiatrist to request a consult (call operator if needed).
  2. Psych CL team should confirm that the patient requires inpatient psychiatry admission.
  3. Verify that labs, imaging and other tests have been completed and are normal.
  4. Document that the patient is “medically cleared.” This means that the patient does not need to be in a medical hospital for acute medical/surgical reasons.
  5. Contact the Emergency Psychiatry Access Team (EPAT) via pager at 36311 or call 216-983-4899 to make a referral. Provide patient’s name, medical record number and a brief description of his or her psychiatric symptoms.
  6. Ensure that there is a legal status for the patient – either a voluntary form signed by the patient or an involuntary admission form (pink slip) properly filled out and signed by a physician.
  7. EPAT will remain in contact with the primary team regarding placement. Once EPAT confirms inpatient psychiatric bed availability at a specific location, unit personnel should call the accepting hospital and Rural Metro ambulance service.
  8. Prior to discharge, the patient must have a discharge order entered in the EMR. Records – including the original legal document and copies of pertinent chart elements (e.g., nursing notes, EKGs, stress test results, medication list, etc.) – should be sent to the accepting hospital along with the patient.

Transferring Patients to a Psychiatric Unit

  1. Patient must be accepted to an inpatient psychiatric hospital and must have a valid legal status (voluntary or involuntary).
  2. During regular work hours (Monday – Friday from 9 a.m. – 5 p.m.), unit personnel should page the Rural Metro Liaison on pager 31951. During evenings and weekends, unit personnel should call 216-749-2211.
  3. Unit personnel will need to provide Rural Metro with the following patient information:
    • Name and MRN
    • Demographics
    • Weight
    • Whether patient is on oxygen or IVs (unusual if transferring to psychiatric unit)
    • Whether patient is in soft or locked restraints
    • Legal status (voluntary or involuntary)
  4. Insurance information: If patient is uninsured, the transfer should be billed to the “General UH Fund”.

NOTE: An ambulance is required since the patient will need supervision. Patient is to remain in hospital clothing for the transfer process. Hospital records and personal belongings should be given to the Rural Metro transport personnel.

Required Testing Prior to Psychiatry Admission

The following tests are needed before a patient can be admitted to a psychiatric unit:

  • Complete blood count (CBC) with differential, comprehensive metabolic panel (CMP), urinalysis with culture and sensitivity (C/S), thyroid stimulating hormone (TSH)
  • Urine toxicology, blood toxicology, blood alcohol level
  • Urine pregnancy test for appropriate patients (females under 60 years old). NOTE: if patient is over 20 weeks gestation, ultrasound will be necessary for clearance
  • Blood levels of applicable medications
  • Creatine kinase (CK) if patient has urine toxicology positive for cocaine or recent CK elevations
  • Head imaging (CT or MRI, as able) whenever patient has new-onset psychosis, recent head trauma, recent stroke or any lateralizing neurologic symptoms
  • 12-lead EKG

Other labs or tests may include:

  • B12
  • Folate
  • Syphilis testing
  • HIV
  • Lumbar puncture
  • Blood/urine/cerebral spinal fluid cultures
  • EEG
  • Other tests deemed necessary by Psych CL team in conjunction with primary team
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