Program Management Circulars Index <

Out of Area Patients - January 2000

• Purpose
• Background
• Recommendations
• Psychogeriatric and Adolescent Admissions
• Financial Responsibility
• Practice Standards

Purpose

To advise you of the responsibilities of Area Mental Health Services (AMHS) in relation to finding a bed for out-of-area patients. These guidelines apply to adult, psychogeriatric, and adolescent patients.

Background

Recent queries have been received from AMHS regarding responsibility to find a bed for out-of-area patients in need of admission. The following should be read in conjunction with Program Management Circular No. 3/95 ‘Accessing Services Across Regions and Areas’.

Recommendations

The overall principles in considering out-of-area placements are that:

• The paramount consideration must always be the well being and safety of the patient and community.
• All patients who present for admission to an in-patient service are properly assessed with regard to their mental status and risk to self and others, regardless of their area of origin.
• Where it is determined that there is a need for admission, and the patient is out of area, the AMHS to which the patient presents is responsible for the patient’s immediate management, and must notify the patient’s area of origin service of the situation.
• Where the patient is awaiting transport and admission to another hospital, the duty of care resides with the AMHS to which the patient has presented, and the AMHS must determine and provide interim clinical management.
• Where the patient’s area-of-origin service has no bed available, it is the responsibility of the Authorised Psychiatrist/delegate of the presenting AMHS to either admit the patient, or locate an appropriate bed elsewhere at the cost of the patient’s area-of-origin service.

Psychogeriatric and Adolescent Admissions

In circumstances where an acutely disturbed psychogeriatric or adolescent patient cannot be safely admitted to a psychogeriatric or adolescent service and requires admission to an adult service, it is the responsibility of the Authorised psychiatrist/delegate of the presenting service to either admit the patient to an adult bed, or locate an appropriate adult bed elsewhere.

In circumstances where a psychogeriatric or adolescent patient cannot be safely admitted to a psychogeriatric or adolescent service, then the responsibility to find an appropriate bed, and/or clinical management resides with the service to which the patient presents.

Financial Responsibility

Guidelines on financial responsibility for out-of-area services are detailed in the Program Management Circular No. 3/95 ‘Accessing Services Across Regions and Areas’.

Practice Standards

The following practice standards apply to out-of-area placements:

• All patients who present for admission must receive a thorough and documented assessment of their service needs.
• Where the patient is held-over in the presenting hospital, pending transfer to another hospital, all treatment and care is documented and meets appropriate standards of practice for in-patient management.
• Documentation must indicate that the patient’s area of origin service has been notified within 24 hours of the out-of-area admission.