Consultation–liaison psychiatry training and supervision results in fewer recommendations for constant observation

Abstract

In this study, we tested two hypotheses. First, that consultation-liaison (C–L)-trained psychiatry residents would order constant observation (CO) less frequently than psychiatry residents untrained in C–L. Second, we predicted that CO would be ordered less frequently under circumstances when experienced C–L psychiatry attending and fellows would be available to supervise psychiatry residents training in C–L. We reviewed a total of 138 consultations during a 6-month period. Constant observation was recommended in 31 cases (22.5%). Consultations were done by residents who had received training in C–L psychiatry ( n=34) and by residents who were not trained in C–L ( n=34). Residents not trained in C–L had a significantly higher percentage of CO orders (44.1%) compared to those trained in C–L (15.4%) (χ 2=12.1, df=1, P<0.001). Because C–L-trained residents provided regular-hour and after-hour consults while residents without C–L training provided only after-hour consults, we also separately analyzed data from the 102 after-hour cases. We again found that residents with C–L training had a significantly lower rate of ordering CO (22.1%) than those who had not yet received C–L psychiatry training (44.1%) (χ 2=5.31, df=1, P<0.05). We also found that C–L-trained residents ordered CO less frequently during regular hour consults (2.8%) when experienced staff are available in supervision compared to after hours (22.1%) (χ 2=6.72, df=1, P<0.01). Our findings suggest that training in C–L psychiatry has a significant impact on the use of constant observation for patients in the general hospital thereby reducing the cost of care.