2026 Southeastern Residency Conference

Title: Evaluation of Discharge Process from a High Intensity Psychiatric Unit at a Veteran’s Health Care System

Author’s names: Dalton V. Scott, Lynsey Neighbors, Anisa Britt, Perry Thompson

Background: The Central Alabama Veterans Health Care System (CAVHCS) High Intensity Psychiatric Unit (HIPU) provides mental health (MH) crisis intervention and stabilization to veterans, followed by discharge to the most appropriate level of care, including continued medication management in the outpatient setting. Pharmacy services contribute to this process through discharge medication reconciliation and dispensing the prescribed discharge medications. This project aims to evaluate the timely and appropriate scheduling of follow-up with outpatient MH services as indicated by VHA Directive for veterans discharged from the HIPU to ensure continued medication management in the immediate post-discharge period, and the rates of readmissions related to acute MH within 90 days of discharge.

Methods: This is a retrospective, observational chart review of veterans discharged from the CAVHCS HIPU from 10/01/2024 to 04/22/2025. Exclusion criteria were as follows: veterans with irregular discharge circumstances (e.g., left Against Medical Advice), those transferred to another level of care (e.g., long-term rehabilitation), or those readmitted in the 90-day post-discharge period for non-MH treatment. Primary outcomes included: the rate of veterans who completed outpatient MH prescriber follow-up within ≤ 7 days, 8-30 days, and 31-90 days post-discharge; the rate of readmission for acute MH treatment within 90 days; and the average time to acute MH-related readmission. Secondary outcomes included the rate of pharmacist-entered discharge medication reconciliation notes and the rates of discharge MH medications by class.

Results: Among 166 HIPU discharges, nearly 58% had no outpatient MH follow-up. 15% had scheduled follow-up within ≤ 7 days, followed by 10% within 8-30 days, and 7% within 31-90 days. 3% had walk-in appointments at 8-30 days, and 7%  of walk-in appointments occurred at 31-90 days post-discharge. 34% of discharges resulted in readmission within 90 days. 80% of readmissions had no outpatient MH prescriber follow-up. Of those not readmitted, 46% also lacked outpatient MH prescriber follow-up. Pharmacists provided discharge medication reconciliation to 27% of readmitted veterans while 7% of readmitted veterans did not receive the service. Pharmacists provided discharge medication reconciliation to 56% of non-readmitted veterans while 10% of non-readmitted veterans did not receive the service. The evaluated 536 post-discharge MH medications stratified by medication class were as follows: 28% antidepressants, 18% antipsychotics, 2% benzodiazepines, 2% extrapyramidal symptom agents, 4% mood stabilizers, 16% non-benzodiazepine anxiolytics, 27% sleep agents, 2% substance use disorder agents, and 1% long-acting injectable antipsychotics.

Conclusions: The data indicate that the HIPU discharge process is not aligned with VHA Directive, as over half of the discharges evaluated lacked outpatient MH prescriber follow-up. Alarmingly, 80% of readmissions were comprised of veterans who did not receive outpatient follow-up care within the 90-day post-discharge evaluation period. As HIPU providers only provide outpatient prescriptions for 30-day supplies, a lack of appropriate follow-up increases the risk of acute MH relapse. Establishing effective transition processes, timely scheduling, and ensuring continuity of care are essential to mitigate these risks and improve patient outcomes. Pharmacists play a crucial role in preventing HIPU readmissions, as supported by the finding that over half of patients who received pharmacy discharge medication reconciliation were not readmitted within the 90-day post-discharge period. This highlights the importance of pharmacist involvement in discharge processes to improve patient outcomes and reduce readmission rates. These findings provide compelling evidence for implementing processes to improve transitions of care and to advocate for increased pharmacy involvement for veterans discharged from the HIPU.