Medical Clearance Workgroup

Securing inpatient psychiatric services for individuals who present at emergency departments has become increasingly complex and time consuming over the last decade. This trend of “Emergency Department Boarding” has generated a national conversation which recognizes that psychiatric patients that are most in need of inpatient services are often made to wait the longest for a host of complicated reasons. In July 2017, the Michigan Department of Health and Human Services (MDHHS) launched the Michigan Inpatient Psychiatric Admissions Discussion (MIPAD) workgroup to investigate ongoing barriers to accessing inpatient psychiatric services in Michigan.

The MIPAD Workgroup identified medical clearance as one of the barriers to timely access to inpatient psychiatric services. “Medical clearance” is the process where an emergency department clinician evaluates an individual who may require psychiatric admission for other medical or surgical conditions. The MIPAD Workgroup concluded that (1) the requirements for the medical clearance process vary significantly from hospital and hospital and (2) disagreements between emergency department clinicians and admitting providers over whether an inpatient psychiatric unit can provide appropriate and safe care to individuals with co-occurring medical or surgical conditions frequently leads to breakdowns in the admissions process.

To address this barrier, MDHHS and the Michigan Health and Hospital Association (MHA) convened a workgroup of emergency medicine and psychiatric specialists across disciplines of medicine, pediatrics, psychology, and nursing along with administrative experts in hospital management and state policy. This workgroup met several times over the last few months, examined the literature on this issue, heard from other state experts, and developed the guiding framework.

Medical Clearance Workgroup Framework


MDHHS, MHA, and the workgroup are seeking feedback to refine and maximize the impact of this framework. Stakeholders can either submit feedback by email or through the web-based survey.



SURVEY:                               Survey Monkey Link 


Once the framework is finalized, MDHHS, MHA, and the workgroup will work to support the adoption of the final document and foster more standard practices related to medical clearance across emergency departments and hospitals with psychiatric units.