“Hospital-based systems have their own unique challenges. One of the principal ones is: if someone has received benefit from ketamine or esketamine and doesn’t want to pause treatment, how do you persist when hospitalized, and when should a hospital consider recommending initiation of ketamine or esketamine?”
— Dr. Benjamin Yudkoff, Chief Medical Officer and Co-Founder at Lumin Health
Across inpatient psychiatry units and emergency departments, hospital staff are increasingly encountering patients who have already begun ketamine therapy or Spravato treatment in the community — or who might benefit from it after discharge.
Yet the transition between acute stabilization and outpatient continuity can be the most complicated, influenced by the hospital system’s own access to internal referral sources and familiarity with outpatient resources. As Dr. Yudkoff notes:
“The best partnerships aren’t about applying a set program. It’s about communication — dealing with each circumstance as it arises, understanding the needs of the system which is caring for a patient and adjusting to it.”
This article outlines a structured yet flexible roadmap for consulting psychiatrists, ED teams, and discharge planners: how to identify candidates for ketamine therapy or esketamine (Spravato), ensure safety after discharge, and coordinate rapid outpatient follow-up so that early progress is not lost.
Consults, Discharge Planning, and Rapid Follow-Up Considering Ketamine Therapy after Hospital Stays
Eligibility signals during ED/consults
During psychiatric consults or inpatient evaluations, certain clinical signals should prompt consideration for ketamine therapy or esketamine (Spravato) referral:
- Treatment-resistant depression (two or more antidepressant failures).
- Major depressive episodes with suicidal ideation.
- Good medical stability.
- Difficulty maintaining stability as an outpatient.
- Interest in modalities like ketamine or esketamine.
These criteria align with the populations where rapid-acting antidepressant effects are most supported. Hospitals need not initiate ketamine directly, but can begin the evaluation conversation while the patient is still inpatient.
“We’re happy to work with hospitals to provide continuity of care in the hospital-based system,” Dr. Yudkoff notes. “We are also equipped to perform no-cost medical-necessity evaluations while the person is still on the unit — to determine if ketamine or esketamine is even something to consider, and work with disposition teams to ensure streamlined, post-hospital follow up.”
This early screening helps prevent discharge delays and avoids gaps in psychiatric planning once the patient leaves the hospital.
Safety and escalation plan post-discharge
Every handoff from hospital to community carries risk — especially for patients recovering from suicidality or severe depression.
We help inpatient teams develop a plan:
- A treatment team that is ready to engage the patient.
- A service line that generates hope and future orientation.
- A willingness to partner with other outpatient providers and members of the patient’s support network.
Dr. Yudkoff emphasizes that continuity defines the partnership.
Scheduling first clinical ketamine dose
Momentum matters. Patients who express interest in ketamine therapy or Spravato treatment during admission are often motivated, but that readiness fades if the logistics become complex.
“We meet patients flexibly, where they are. We can consult with inpatient teams and evaluate eligibility and safety of the treatment for patients still in the hospital. We closely coordinate with inpatient teams to bring the treatment start date within the target discharge date.” That ensures persistence and continuity of care.”
Discharge planners can strengthen this bridge by:
- Flagging eligible patients for medical-necessity review for ketamine treatment before discharge.
- Coordinating ketamine / esketamine appointments directly with the outpatient clinic prior to the patient’s release.
- Confirming transport, insurance, and support systems to and from ketamine therapy locations during discharge planning.
These seemingly small operational steps often determine whether early improvement consolidates — or dissipates.
Ketamine Therapy and Hospitals: A Model of Collaboration That Reflects Real-World Complexity
Hospital systems operate under immense pressure: manage risk, ensure that the number of patients waiting for treatment can be seen, and discharge safely. Lumin Health’s approach invites hospitals to think of partnership as extension: a way to keep patients connected to care beyond the inpatient walls.
“We understand hospitals are under a lot of pressure to facilitate healthy discharge,” he says. “Lumin Health is aware of those pressures and wants to help answer those particular concerns.”
Whether through in-unit evaluations, post-discharge scheduling, or outcome reporting back to your EMR, the guiding principle remains the same: communication is a part of the clinical treatment.
