CME 19/12/13 Medical Clearance of the Psychiatric Patient

Here is Gareth’s stimulating talk on medical clearance of the psychiatric patient. Some points worth reiterating are:
  • Hx: Take a focused medical and psych history, including collateral history, if available
  • Ex: Examine the patient and check their physiological parameters (HR, BP, Temp, RR, SaO2)
  • Ix: Based on your history and examination determine whether they are low or high risk of having medical issues, hence if they need further investigation and what those Ix may be
  • Assessment conclusions may include:
    • No psychiatric or medical issues requiring further psychiatric or medical assessment (ie chronic behavioural issues with management plan)
    • Acute medical issues needing to be addressed, or potential medical issues needing to be excluded, before admission to a psychiatric unit (ie. toxicological issues post overdose)
    • Primary medical pathology causing altered mental state, and hence requiring medical admission and treatment
    • Medically cleared for admission to a psychiatric unit = No acute medical issues that require medical unit or further emergency department admission
    • Medically cleared for admission to a psychiatric unit but with some minor medical issues, that the psychiatric team are aware of, that may be managed on that unit

Your assessment should be clearly documented in the patient notes and communicated to staff, so all relevant parties are aware of the plan. There was some discussion whether there was a need for a formal documentation sheet to ensure adequate assessment and a record of this, similar to the Physical Assessment for Mental Health Patients Form (below) developed by the Emergency Care Institute (ECI) NSW from those used at Liverpool and Bankstown Hospitals (Bankstown form here & associated presentation here). The use of such a form will be reviewed by the consultant group in the near future:

Medical clearance for MH pts

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