Justifying inpatient admissions at a community mental health center.

A model for screening and reviewing inpatient psychiatric admissions at a community mental health center is presented in which the process, including the use of both a diagnostic criteria set and a functional criteria scale, is described. Results of a time-limited experimental program indicated that the diagnostic criteria set could be applied in approximately three fourths of the admissions, while the scale of function could be utilized in all cases. Also, a statistically high rate of concordance was found both when the two methods were used by the same evaluator, and when two independent evaluators were employing the same method. At the conclusion of the final review, 6 of 273 admissions or 2.2 per cent were unjustified. The pilot program demonstrated that 90 per cent of the admissions could be screened adequately by nonphysicians. The average time expended by in-house staff including screeners, reviewers, and supportive staff was estimated to be 58.4 minutes per admission with an average direct cost per case of $6.68. Had the review been performed by physicians in local practice, the average cost per case was estimated to be $8.93. The six unjustified admissions represented an average reviewing cost of about $240 per case.