These tools were presented at the Health Care Compliance Association’s Compliance Institute by Katherine Bornstein, entity compliance officer at MedStar Health in Baltimore, Maryland; attorney Allison Luke of AK LUKE, LLC Healthcare Compliance Consulting; and Rebekah Stewart, chief ethics and compliance officer of Diamond Healthcare. Contact Bornstein at katherine.b.bornstein@medstar.net, Luke at aluke65@yahoo.com and Stewart at rstewart@diamondhealth.com.
Inpatient Capability and Capacity Documentation Tool
Patient Information:________________________________________________________________
Date/Time of Referral: __________________________ Staff Name: __________________________
FACTORS THAT MAY BE INCLUDED IN CAPABILITY AND CAPACITY TOOL (choose objective measures that are applicable to your inpatient behavioral health unit to assess acuity, staffing, etc.):
| Current Unit Acuity | Current Census |
| Current Bed Availability | Quiet Rooms in Use |
| Bed Closures | Patients on 1:1 |
| Patients on Eyesight | Falls Risk |
| Psychotic Patients | Manic Patients |
| Skilled Nursing Care | Active Withdrawal |
| Active Seclusions | Active Restraints/Physical Assists |
| Admissions in the last 12 hours | Discharges in the last hour |
| Anticipated discharge in the next 2 hours | Special Staffing Issues |
If patient is not accepted for admission to inpatient behavioral health unit, physician must document reason:
__________________________________________________________________________________________
__________________________________________________________________________________________
Physician Name:____________________________________________________________________________________
Date/Time of Decision:______________________________________________________________________________
Include details of referral/notification to requestor, etc., depending on your workflow.
