The smart medical clearance protocol as a standardize clearance protocol for psychiatric patients in the emergency department

In 2009, Sacramento County Mental Treatment Center (SCMHTC) shut down half of the 100 inpatient beds in the only Crisis Stabilization Unit (CSU) in the county causing patients who depended on the county mental health with limited resources. The lack of resources in the community resulted in long wait times for appointments in the county outpatient facilities. Due to these complications, psychiatric patients resorted to the Emergency Departments (ED) for their treatment, causing an influx of psychiatric patients, poor and sometimes sub-therapeutic care from the ED clinicians. To formulate a better process to care for the patients in the ED, the Mental Health Improvement Coalition comprising of leaders from the Hospital Council of Northern and Central California region and other stakeholders worked with Sacramento County healthcare providers with goals of reducing the incidence of psychiatric crisis in the ED. The proposal included a strategy to ensure that psychiatric patients have access to quality medical care, both when they present to the ED, and when they transfer to the psychiatric inpatient facilities. This lead to a proposal to standardize the medical clearance process across all EDs in the Sacramento region, and inpatient psychiatric treatment programs. To facilitate the timely transfer of patients to appropriate treatment centers, the SMART medical clearance protocol was developed to provide a guide for ED physicians to medically stabilize patients.