MI-SMART: A Consensus-Based Approach to Medical Clearance Before Inpatient Psychiatric Admission

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Authors

• Hailey Raab, Michigan State University College of Human Medicine Medical Student
• Rayna Edwards, Michigan State University College of Human Medicine Medical Student
• Juan Jimenez, Michigan State University College of Human Medicine Medical Student
• Justin Romero, Michigan State University College of Human Medicine Medical Student
• Hussein Kansou, Michigan State University College of Human Medicine Medical Student
• Raine Johnson, Michigan State University College of Human Medicine Medical Student
• Girish Sivakanthan, Michigan State University College of Human Medicine Medical Student
• Andrea Ramirez, Michigan State University College of Human Medicine Medical Student
• Tom Peterson, Emergency Medicine - Corewell Health West
• Meredith Busman, Emergency Medicine - Corewell Health West

Description

To evaluate the impact of implementing the MI-SMART consensus-based medical clearance algorithm and standardized form on emergency department (ED) length of stay (LOS), diagnostic testing, and safety among patients requiring medical clearance for inpatient psychiatric admission.

This retrospective before-and-after cohort study compared ED encounters for adult and adolescent patients (> 12 years of age) requiring medical clearance for inpatient psychiatric admission during 10 months before and 10 months after implementation of the MI-SMART algorithm and standardized form. Data abstracted included demographics, visit characteristics, MI-SMART category (post-period), diagnostic testing, ED length of stay (LOS), and short-term safety outcomes such as serious return visits, ICU transfers, and mortality. Outcomes will be analyzed using descriptive statistics and multivariable regression models to compare ED length of stay, test utilization, and safety between pre- and post-implementation periods.

A total of 140 ED patients met the inclusion criteria and were transferred to a psychiatric facility during the study period. Overall, 78 (55.7%) were in the pre-implementation cohort, and 62 (44.3%) were in the post-period with a completed MI-SMART form. The mean age was 30.9 + 16.9 years (range 13.5 to 78 years); 73 (52.1%) were female. Demographics, comorbidity, visit characteristics and psychiatric diagnoses were similar between the two cohorts. Common diagnoses were suicidal ideation (43.1%), acute psychosis (12.3%), depression (9.5%), and substance abuse (8.2%). ED LOS was similar between the two cohorts (12.8 vs. 13.1, p = 0.82). There were also no differences in test utilization or in short-term safety outcomes despite adjustment for key confounders.

Implementation of the MI-SMART consensus-based medical clearance algorithm and standardized form did not significantly change ED length of stay, diagnostic test utilization, or short-term safety outcomes among patients transferred for inpatient psychiatric care. However, MI-SMART facilitated a structured, standardized approach to medical clearance, with no evidence of harm. These findings suggest that consensus-based tools such as MI-SMART can be implemented to improve process consistency without adversely affecting ED throughput or patient safety.

Publication Date

5-8-2026

Disciplines

Emergency Medicine

Recommended Citation

Raab H, Edwards R, Jimenez J, Romero J, Kansou H, Johnson R, Sivakanthan G, Ramirez A, Peterson T, Busman M. MI-SMART: A consensus-based approach to medical clearance before inpatient psychiatric admission. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1894