Use of Passes on a General Hospital Psychiatric Unit

The use of a pass must be carefully documented and the patient's clinical status at the time a pass is used clearly noted. Since patients who are suicidal at admission are frequently prescribed passes, it is imperative to note their potential for self-destructive behavior. At the hospital in this study, an unsettling proportion of passes, 30 percent, were not fully explained in the hospital's records. This lack of documentation may indicate a serious flaw in record keeping and may even suggest there was no clear rationale for the pass.

Acute psychiatric services may find it useful to view passes as "therapeutic assignments". As part of the assignment, staff should carefully document the rationale and duration of the pass, where patients will be spending time during their absence, what medications they will taking, who will accompany them, and the goals to be achieved while the patient is absent. It may be helpful to formally include patients in this process by asking them to complete a written statement of goals to be achieved and parameters to be observed while they are using a pass. The statement might document any discussion of activities the patients plan to engage in, including driving and using drugs and alcohol.

Practical considerations may make it important to justify a pass. Third-party insurers may not fully understand the use of such tactics and may try to deny the hospital reimbursement for the patient's care. Thus it is essential to fully document the rationale and outcome of such therapeutic assignments.

Before coming to any conclusions about the value of the hospital pass, however, further data are needed to better document its rationale and effect.