Psychiatric expertise in clinical decision making for psychiatric inpatients

Hospital boards and medical staffs are faced with difficult decisions about whether nonphysician mental health professionals should be given admitting privileges to psychiatric hospitals or treatment units. The authors describe the special medical expertise of the psychiatrist and define 11 indicators, such as a patient's need for new psychotropic medication or the presence of symptoms requiring medical or laboratory procedures, that can be used to determine whether psychiatric expertise is needed. The indicators were applied to a group of ten patients who constituted all admissions to a treatment unit in a private, nonprofit psychiatric hospital in a one-month period. At least half of the indicators were relevant to all the patients studied, suggesting the need for management by a psychiatrist.