PRACTICE GUIDELINES FOR PSYCHIATRIC PARTIAL HOSPITALIZATION
The Guidelines of Practice for Medical Psychiatric Partial Hospitalization were developed by the Professional Practices Committee of the Texas Society of Psychiatric Physicians and were adopted by the TSPP Executive Council on February 27, 1994. Amendments to the document were adopted by the TSPP Executive Council on April 26, 1998, May 28, 2000 and April 6, 2014. TSPP is the Texas District Branch of the American Psychiatric Association.
These Guidelines are not considered to be prescriptive for all patients due to the wide variety of circumstances associated with the presentation of patients for psychiatric care.
A. Criteria for Psychiatric Partial Hospitalization
1. A psychiatric partial hospitalization program shall have a Medical Director. The Medical Director is a psychiatrist who is licensed to practice medicine, who is either Board Certified or on an approved path toward certification, and who is credentialed and privileged by the medical staff to oversee and be responsible for the clinical care of patients, the Performance Improvement Program, and the Utilization Review Program of the psychiatric partial hospitalization program.
2. Each patient shall have an attending psychiatrist who is responsible for the patient’s care and treatment plan. The psychiatrist shall be privileged, and credentialed on the hospital medical staff.
3. A physical examination and a psychiatric history shall be performed and documented in the patient’s medical record.
4. Vital signs shall be obtained and monitored in an appropriate fashion as ordered by the attending psychiatrist, and shall be documented in the patient’s medical record.
5. Appropriate laboratory and diagnostic assessments shall be performed as ordered by the attending psychiatrist, and documented in the patient’s medical record.
6. Orders for appropriate medicines shall be entered in the patient’s medical record by the attending psychiatrist and dispensed or taken from the patient’s own supply as ordered.
7. Performance Improvement, Risk Management, and Utilization Review shall be active, in place, and monitored by the Medical Director.
8. A licensed therapist shall be available for taking social histories, and for performing group therapy, family therapy, and if indicated and ordered by the attending psychiatrist, individual therapy.
9. A nurse shall be present at all times to monitor the patient’s psychiatric and general medical status, to administer medications, and to observe the patient for potential side effects.
10. A pharmacist shall be available to consult on medications, dosing, interactions, and side effects.
11. Laboratory services shall be available to perform emergency laboratory studies.
12. Procedures shall be in place to triage acute medical emergencies.
13. Procedures shall be in place to safely manage acute psychiatric emergencies and to facilitate expeditious transfer of patients to an appropriate inpatient facility when necessary.
1. These guidelines are considered by the TSPP Professional Practice Management Committee to be minimum guidelines for the delivery of care to patients in a psychiatric partial hospitalization program.
2. The attending psychiatrist shall have responsibility, which shall not be delegated to a non-physician, for the admission to, transfer to, or discharge from a partial hospitalization program.
3. The attending psychiatrist shall promptly evaluate a patient who becomes actively suicidal or homicidal in a psychiatric partial hospitalization program for consideration of transfer to a psychiatric inpatient facility.
4. The attending psychiatrist shall have primary responsibility for review of physical examinations, review of consultations, review of progress notes, review of vital signs, review of medications, review of laboratory studies, personal contact with the patient, informal discussions with staff members concerning the patient’s progress, progress note documentation, and treatment team leadership.
5. The attending psychiatrist shall comply with existing laws regarding involuntary commitment, confidentiality, informed consent, patients’ rights, patient abuse and neglect, and shall conform to the standards and guidelines of the American Medical Association and the American Psychiatric Association regarding ethical conduct.
6. If the attending psychiatrist’s practice deviates from these guidelines, the attending psychiatrist shall document in writing in the patient’s medical record the rationale for this deviation.
1. A patient presenting for evaluation for potential admission to a psychiatric partial hospitalization program shall be examined by a physician prior to admission to the psychiatric partial hospitalization program in accordance with current state and federal law and regulations.
2. Patients appropriate for admission to a partial hospitalization program are those who are neither actively suicidal nor homicidal, and whose psychiatric status, although not of sufficient severity to require inpatient hospitalization, is too severe to benefit from ordinary outpatient care.
D. Physician Visits
1. Patients in a psychiatric partial hospitalization program who are attending the program five (5) days or more per week, shall be seen on rounds by the attending psychiatrist a minimum of two (2) days a week. Patients attending the program less than five (5) days per week shall be seen by the attending psychiatrist a minimum of one (1) day per week.
2. The attending psychiatrist shall spend sufficient time on rounds with each patient and with psychiatric partial hospital staff to ensure that the patient’s current clinical status has been adequately assessed and the course of treatment appropriately monitored and modified if necessary.
1. An initial psychiatric assessment shall be performed and documented by the attending psychiatrist within twenty-four (24) hours of admission (excluding weekends, holidays, and days when the patient is not in attendance).
2. The initial psychiatric assessment shall include the following: chief complaint or presenting problems, history of the present illness, past psychiatric and medical histories, family and (for children and adolescents) developmental histories, social history, and mental status examination. If the patient has been transferred to a psychiatric partial hospitalization program from another level of care, a copy of the previous psychiatric assessment shall be placed in the patient’s medical record, and a transition/update progress note shall be entered into the record by the attending psychiatrist.
3. Physical examinations shall be completed and documented within seventy-two (72) hours of admission (excluding weekends, holidays, and days when the patient is not in attendance). The medical record shall include appropriate laboratory results and the results of other diagnostic studies. If the patient has been transferred to a psychiatric partial hospitalization program from another level of care, copies of the previous physical examination, laboratory results, diagnostic studies shall be placed in the patient’s medical record.
4. Other sources of information, such as interviews with family members, and psychological testing shall be placed in the patient’s medical record.
5. A progress note shall be entered in each patient’s medical record by the attending psychiatrist at the time the patient is seen on rounds. The progress note shall address the patient’s current clinical status, progress, and response to treatment, including response to medications ordered by the attending psychiatrist. The progress note shall be sufficiently detailed to permit another psychiatrist unfamiliar with the patient to understand the rationale for psychiatric partial hospitalization and the patient’s treatment plan.
F. Treatment Team Contact
1. The attending psychiatrist shall have sufficient direct contact with other members of the patient’s treatment team to exert an appropriate level of leadership in managing the patient’s care.
1. The patient’s attending psychiatrist shall be sufficiently familiar with the cost of the patient’s care to discuss this with the patient.
2. No treatment modality shall be provided to the patient unless ordered by the attending psychiatrist or a consultant whose consultation has been requested by the attending psychiatrist.
3. The attending psychiatrist shall seek consultation by another psychiatrist if the attending psychiatrist encounters a difficult or complex clinical or diagnostic problem that could be appropriately addressed by such consultation.
On April 26, 1998, the TSPP Executive Council adopted an amendment to change the title of the document to Guidelines of Practice for Medical Psychiatric Partial Hospitalization and to change references to “standards” in the document to “guidelines” where appropriate.
On May 28, 2000, the TSPP Executive Council approved a name change of the Professional Standards Committee to the Professional Practices Committee.
On April 6, 2014, the TSPP Executive Council approved changes to the Guideline as recommended by the Professional Practice Management Committee.