Abstract
BackgroundWe describe the way psychiatric issues are addressed by inpatient medical teams through analysis of discussions of patients with behavioral health concerns and examination of teams’ subsequent consultation practices.MethodsWe observed morning rounds for nine inpatient medical teams for approximately month-long periods, for a total of 1941 observations. We compared discussions of patients admitted for behavioral health related medical conditions between those who did and did not receive a psychiatric consultation, developing categories to describe factors influencing consultation or other management.ResultsOut of 536 patients, 40 (7.5%) received a psychiatry consult. Evaluation of a known concern (i.e., substance use, affective disorder, or suicidal ideation) was the most common reason for referral (41.7%). Requests for medication review were second (30.6%). Thirty patients with concomitant behavioral and medical health issues did not receive a psychiatry consult. Cirrhosis with active substance use was the most common medical diagnosis (15), followed by alcohol withdrawal (9).ConclusionsFour primary themes emerged from our data: positive identification of behavioral health issues by physicians, medication management as a primary reason for referral, patient preference in physician decision-making, and poor management of substance abuse. Our results identify two potential areas where skills-building for inpatient physicians could have a positive impact: management of medication and of substance abuse management.
Highlights
We describe the way psychiatric issues are addressed by inpatient medical teams through analysis of discussions of patients with behavioral health concerns and examination of teams’ subsequent consultation practices
We identified the overall set of patients who received psychiatric consultation, along with the set of patients with active behavioral health or psychiatric issues at the time of admission
Of the subset of 10 of these patients for whom we reviewed all patient care discussions, two patients were considered too disoriented for referral and one patient’s behavioral health issues were considered chronic and being managed by outpatient services
Summary
We describe the way psychiatric issues are addressed by inpatient medical teams through analysis of discussions of patients with behavioral health concerns and examination of teams’ subsequent consultation practices. An extensive body of literature indicates high prevalence of psychiatric and behavioral health disorders in hospitalized medical patients [1, 2]. Previous literature suggested a lack of recognition of inpatients’ behavioral health issues by non-psychiatrist physicians and, a lack of appropriate. Psychiatric and behavioral health consultation rates have remained consistently low over time and previous research may not accurately assess the extent to which inpatient physicians recognize and address patients’ psychiatric conditions directly [2, 11]. Liaison psychiatry and other behavioral health inpatient consulting services are commonplace, suggesting that availability of services may not be a contributor to low referral rates [1]. Few studies have examined the reasons for low rates of consultation
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
