Service Use in Consultation-Liaison Psychiatry: Guidelines for Baseline Staffing

Abstract

The aim of this study was to determine how referrals and clinical activity in consultation-liaison psychiatry (C-L) vary according to unit type and size, length of stay and psychiatric diagnosis, and to use these data to inform recommendations for the minimum levels of staffing required to conduct consultations in a general hospital. Data were collected across three urban teaching hospitals over a 5-year period. The data included hospital admission data, referrals, psychiatric diagnosis, clinical contact time, clinical equivalent full time (EFT) and a measure of 'busyness'. Mean clinical staffing was 0.84 EFT per 100 beds. Services received a mean of 2.4 referrals per 100 hospital admissions. On average, each referral generated 3.9 contacts and a total contact time of 2.6 hours. The contact time was greater in patients with multiple psychiatric diagnoses as compared with a single or no diagnosis. In order to provide a minimum level of service for consultations to the expected range of serious and immediate psychiatric disorders present in the general hospital, a C-L service requires about 1.0 clinical EFT per 100 beds. For services to be able to address more complex elements of illness behaviour, provide education, conduct research, contribute to comprehensive care in specialist areas and undertake other liaison activities, greater and more multi-disciplinary EFT is required.