What to Communicate When Calling the Acute Hospital
When calling the acute hospital, immediately state that you are referring a patient requiring urgent psychiatric assessment due to concerns about their mental state and safety, then provide a structured clinical summary covering medical stability, psychiatric risk factors, and specific reasons why outpatient management is unsafe. 1
Essential Information to Communicate
Opening Statement
Begin by identifying yourself, your role, and clearly state: "I am calling to arrange urgent psychiatric assessment for a patient I am concerned about regarding their mental state and safety." 1
Medical Clearance Status
Confirm the patient's medical stability first, as psychiatric teams require this information before accepting transfer. 2
- State vital signs (blood pressure, heart rate, temperature, respiratory rate) 2
- Report mental status: alert, oriented, cooperative vs. altered, agitated, or confused 2
- Mention any concerning physical findings: signs of self-injury, toxidromes, neurological abnormalities 2
- Clarify if medical workup has been completed or if concerning findings require further evaluation before psychiatric placement 2
Important caveat: If the patient has altered mental status, abnormal vital signs, or new-onset psychiatric symptoms, emphasize that medical causes need evaluation—delirium can masquerade as psychiatric conditions. 2 Direct communication between attending physicians may be necessary if there is disagreement about medical stability. 2
Psychiatric Risk Assessment
Provide specific details about suicide risk, as this determines level of care. 2
Communicate whether the patient:
- Continues to endorse desire to die or active suicidal ideation 2
- Remains severely agitated, hopeless, or unable to engage in safety planning 2
- Had a high-lethality suicide attempt or attempt with clear expectation of death 2
- Exhibits psychotic symptoms (hallucinations, delusions) 2
- Shows severe mood disturbance impairing judgment or safety 1
- Has comorbid substance abuse, high impulsivity, or anger 2
Support System and Monitoring Capacity
Explicitly state why outpatient management is unsafe. 2
- Inadequate support system at home 2
- Cannot be adequately monitored by family/caregivers 2
- Barriers to accessing follow-up care 2
- Patient refuses voluntary outpatient treatment 1
Collateral Information
Mention information obtained from family members or witnesses about the patient's state of mind, as patients frequently minimize symptom severity. 2
Current Mental Status Examination Findings
Provide objective observations, not just patient self-report. 2
- Appearance and behavior (agitated, withdrawn, disheveled) 2
- Thought process (disorganized, tangential, racing) 2
- Thought content (suicidal ideation, homicidal ideation, paranoid delusions) 2
- Mood and affect (depressed, anxious, flat, labile) 2
- Insight and judgment (poor, impaired decision-making) 2
Specific Request
Clearly state what you are requesting: "This patient requires inpatient psychiatric admission for comprehensive evaluation and stabilization due to [specific safety concerns]." 1
Common Pitfalls to Avoid
Do not rely on or mention "no-suicide contracts"—these have no proven efficacy and provide false reassurance. 1 Instead, focus on objective inability to engage in safety planning. 2
Do not delay psychiatric evaluation waiting for arbitrary blood alcohol levels or routine laboratory results in alert, cooperative patients with normal vital signs. 2, 3 Base the assessment on cognitive abilities, not specific lab values. 3
Avoid sending patients with concerning vital signs, altered mental status, or new-onset psychiatric symptoms without adequate medical evaluation—these patients need medical causes excluded first. 2
If the Receiving Team Refuses Admission
Request direct attending-to-attending communication if there is disagreement about appropriateness of the referral. 2 Document the clinical rationale for your concern and the receiving facility's response. 1
Consider whether alternative levels of care might be appropriate if inpatient admission is declined: partial hospital programs, intensive outpatient services, or crisis stabilization interventions. 2 However, if the patient meets high-risk criteria (ongoing suicidal ideation, severe hopelessness, inability to safety plan, inadequate monitoring), inpatient admission remains necessary regardless of bed availability. 2