Proactive C-L Psychiatry Beyond Academic Hospital Settings: A Pilot Study of Effectiveness in a Suburban Community Hospital

Abstract

Proactive consultation-liaison psychiatry improves identification of psychiatric needs and reduces time to psychiatric consultation and length of stay (LOS) among medical inpatients in academic clinical settings. To evaluate the effect of a proactive model on LOS, consult rate, and consultation latency in a nonacademic community hospital. We implemented a modified proactive consultation-liaison service (PCS) in a 32-bed acute care medical-surgical unit in a community hospital. We compared outcomes during a 90-day PCS intervention period to preintervention and postintervention cohorts receiving consultation-as-usual in the same unit. During the intervention, a psychiatrist reviewed the electronic medical record of patients admitted to the study unit to guide recommendations and collaborated with existing unit staff. Primary outcomes were LOS, consultation rate, and consultation latency. Secondary outcomes included restraint utilization, 1:1 companion utilization, and a survey completed by unit nursing staff. Half of patients on the study unit had psychiatric comorbidity. Median LOS in the PCS cohort was 3.0 days versus 5.0 days in the preintervention and postintervention cohorts. The consultation rate was higher in the PCS cohort (1.4% before intervention; 33% intervention; 6.5% after intervention), and median consultation latency was also reduced during the intervention (57.6 h before intervention; 19.2 h intervention; 48 h after intervention). Implementation of a modified PCS model is feasible in a community hospital setting and can reduce LOS, enhance psychiatric service utilization, and reduce consultation latency. This study demonstrates that proactive consultation-liaison may offer the same benefits to nonacademic community hospitals as it does to large academic centers.