The scope, pace, and depth of inpatient evaluation depend on the patient population served by the inpatient service, the goals of the hospitalization, and the role of the inpatient unit within the overall system of mental health services available to the patient (40, 41).

In addition to providing a highly structured and contained setting in which patient safety can be monitored and optimized, the inpatient setting permits intensive and continuous observation of signs and symptoms while the patient is being treated for psychiatric and general medical conditions through the collaborative efforts of the multidisciplinary treatment team (see also Section IV.A.5 ). Particularly for individuals with complex psychiatric presentations or multiple co-occurring disorders, the enhanced level of observation in the inpatient environment may facilitate assessment of co-occurring general medical conditions or evaluation for procedures such as electroconvulsive therapy, may aid in resolving diagnostic dilemmas, and may help in determining a patient's ability to function safely and independently in a less restrictive setting (41, 42).

Inpatient settings provide enhanced opportunity to corroborate clinical judgment and decision making, including discharge planning, through access to information from multiple sources. These include the multidisciplinary treatment team, family, friends, and individuals involved in the care of the patient outside the hospital, as well as prior hospitalization records.

From the outset, the inpatient evaluation should include assessment of the patient's access to appropriate treatment following hospitalization. The patient's living arrangements should also be assessed to determine whether they will continue to be suitable after discharge. If the posthospitalization disposition is not apparent, the evaluation should identify both patient factors and community resources that would be relevant to a viable disposition plan and should identify the problems that could impede a suitable disposition. Family involvement, when appropriate, can also be initiated, and goals for inpatient family work can be identified.


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