MI-SMART Psychiatric Medical Clearance


MI-SMART is an effective, standardized tool for determining medical stability for patients with a psychiatric crisis in emergency contexts. Benefits can include improved patient care and more efficient care coordination.


MI-SMART Form Overview

The following video is an overview of the MI-SMART Form. If you are interested in learning more about how your facility can implement the MI-SMART Form, please contact us at MPCIP-support@mphi.org.

The Purpose of the MI-SMART Initiative

The MI-SMART Form is a tool to help providers from behavioral health, including community mental health, emergency medicine, and inpatient psychiatry work harmoniously together and best serve the patient’s needs. 

trianle 2

"Adopting and implementing MI-SMART Psychiatric Medical Clearance criteria at Common Ground has improved patient care and efficient coordination between our stabilization unit, emergency departments, and inpatient psychiatric hospitals. The MI-SMART form provides us a tool that allows for needed communication between providers regarding an individual's crisis needs, focusing on the individual’s acute needs instead of non-pertinent treatment.  The positive results of implementing MI-SMART criteria have been tangible and have made a significant difference in simplifying and standardizing the medical clearance process." 

-Allison Boggess, RN, Program Director

The Medical Clearance process is used to determine whether or not a medical illness is causing or exacerbating a psychiatric condition and if the patient’s physical health is stable enough for him/ her/ them to be transferred to a psychiatric facility or other behavioral health care.   Specifically, MI-SMART, Medical Clearance form, is intended to simplify and standardize the Medical Clearance Process when someone has come to the ED in a behavioral health crisis to be screened for admission into a psychiatric hospital or other behavioral health care. This form may also be used in other settings to help with the Medical Clearance process, such as Primary Care Settings.

“We implemented a 6-month pilot test of the SMART Medical Clearance and Hack’s Impairment Index (HII) in June, 2019.  During that 6 months we experienced shorter lengths of stay for patients in our ED and a significant reduction in ED charges for patients requiring psychiatric admission. There was no decrease in the quality of medical clearance. ED physicians, admitting psychiatrists, and our local CMH all agreed that it was a great success, and we have been utilizing the SMART form (and now the MI-SMART form) ever since.”

–Joe Bonello, Vice President/CNO

The Background of Michigan's Psychiatric Medical Clearance Initiative

In July 2017, Michigan Department of Health and Human Services launched a work group (Michigan Inpatient Psychiatric Admissions Discussion – MIPAD) to investigate barriers to inpatient psychiatric services. One of the recommendations was the development and launch of a statewide Medical Clearance Algorithm.  For more information on other MPCIP Crisis Services Initiatives please visit MDHHS’ MPCIP page

In the last two years, the Michigan Department of Health and Human Services and Michigan Health and Hospital Association led a work group in the development of the MI-SMART form. Statewide feedback was solicited from presentations and disucssions from a broad range of stakeholders, which was then incorporated into the form. This form combines two successful and complimentary methods. This initiative was formally known as MAPAG (Medical Appropriateness for Psychiatric Admission Guide). 

 

Michigan’s Medical Clearance Initiative is called MI-SMART!

 

The current implementation workgroup includes clinicians from Emergency Medicine, Psychiatry, and Psychology, as well as CMHSP representatives and Crisis Services Providers.  

The MI-SMART form has begun it’s statewide rollout period, as of March 1, 2020.

“The use of evidence based SMART and Hack’s tools for medical clearance has led to improved patient care, a decrease (and cost savings!) in unnecessary testing, reduction in harm to patients at risk for alcohol withdrawal, and improved the satisfaction of our ED team members.  In West Michigan, we’re excited to be leading the effort to improve the care of our most vulnerable patients.” 

–Dr. Phillip Stawski, ED Medical Director

View the MI-SMART Form

(this form is the updated January 2021 version)

Please notify us if you are interested in this form. We would like to support you in the implementation! 

MI-SMART picture

 

We would like to acknowledge the Sierra Sacramento Medical Society for their assistance in this initiative. Their SMART form is included as Part 1 of the MI-SMART form.

Are you interested?

Please fill out our contact form. We look forward to collaborating with you!