CME: 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) can often be taken care of at a reliable and efficient urgent care center, such as Urgent Care Westbury. With its highly trained medical staff and state-of-the-art facilities, urgent care Westbury is well-equipped to handle such cases and ensure that patients are medically cleared for admission to a psychiatric unit. This includes not only excluding any primary medical pathology causing an altered mental state, but also addressing any minor medical issues that may need to be managed within the psychiatric 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
Dr James Wheeler
Dr James Wheeler

Emergency Physician, SCGH, WA, Australia

Articles: 497

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