Chapter 4. The Adult Crisis Stabilization Unit
Publication: Textbook of Hospital Psychiatry
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Appendix: Approximate Timeline for an Acute Inpatient Psychiatric Hospitalization
| Day 1—Assessment and crisis management | Day 2—Completion of assessment and initiation of focused treatment | Day 3—Continuation of focused treatment | Day 4—Assessment of safety and discharge readiness | Day 5—Discharge with smooth handoff | |
|---|---|---|---|---|---|
| Assessment | Physician: take history, conduct examination, make formulation, order laboratory tests, consultations Nursing: assess safety and other needs Social work: contact outpatient team/collateral informants, determine legal status and resources BEGIN TO DEFINE THE FOCAL PROBLEM: Why admission here, now? | Finalize presumptive diagnosis, evaluate laboratory results Define mental/physical health needs, reevaluate safety Monitor safety, vital signs, sleep, nutrition, self-care Complete assessment of legal issues, living and financial needs CLEARLY DEFINE THE FOCAL PROBLEM | Assess physical health and psychopathology Monitor safety, vital signs, self-care, sleep Review progress toward defined target outcomes | Assess patient safety and physical/mental health Assess adequacy of self-care and support needs Evaluate response of target symptoms and needs Assess extent to which focal problem has been addressed | Carefully assess patient safety Repeat physical and mental examination Repeat structured assessments, including rating scales |
| Treatment | Establish safety and plan for focused intervention Continue outpatient medications as appropriate Implement safety precautions/monitoring as indicated Plan family/network interventions as appropriate Orient patient to the unit Plan individual therapy as feasible and indicated | Initiate new medication treatment and taper off prior medication as appropriate Use as-needed medications for specific target symptoms as appropriate Implement individual and group therapeutic interventions as appropriate Implement family and other network interventions Implement individualized safety and behavioral/cognitive plan | Continue to implement medication plan Continue group therapy Evaluate effectiveness of and response to interventions Continue family and other network interventions as required Implement medication and other patient education | Complete implementation of medication plan Prepare discharge prescriptions Continue to assess response to various interventions Evaluate learned coping strategies Assess patient and family understanding | Review safety plan Review postdischarge plan with patient and family Continue various interventions as appropriate Dispense postdischarge medications with education |
Finalize and begin definitive interventions Define aftercare needs and develop a plan to address them | Finalize and begin definitive interventions | Concretize postdischarge plan | |||
| Discharge planning | Assess follow-up and living arrangements Assess financial stability and need for assistance Assess employment or educational issues Conduct safety evaluation in likely postdischarge setting Assess other specific needs and issues | Address specific postdischarge needs: legal, living, care, fiscal Define approximate length of stay on inpatient unit | Begin to arrange outpatient appointments Identify likely discharge date Coordinate other postdischarge arrangements as necessary | Identify tentative return-to-work/school date and complete necessary paperwork Complete discharge paperwork Confirm appropriate postdischarge living and care arrangements | Reconfirm and document postdischarge follow-up arrangements Complete all aftercare arrangements Review follow-up plan and confirm patient and family understanding |
| DISCHARGE PATIENT | |||||
Information & Authors
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Published In
Textbook of Hospital Psychiatry
Pages: 87 - 112
Editors: Savitha Puttaiah, M.B.B.S., M.D., and Merle McCann, M.D.
History
Published in print: 3 October 2022
Published online: 5 December 2024
© American Psychiatric Association Publishing
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