The impact of two changes in service delivery on a geriatric psychiatry liaison service.

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The impact of two changes in service delivery (alteration in the admission policy of the medical unit and the introduction of a formal liaison component to a 'consultation only' liaison geriatric psychiatry service) on the associated liaison geriatric psychiatry service was examined in a naturalistic study. The main null hypothesis was that the referral rate would not be influenced by either change in service delivery. The 30-month study period was divided into three phases defined by the two changes in service delivery. The impact of the two changes in service delivery on the (i) referral rate, (ii) reasons for referral, (iii) demographic and clinical characteristics of the referrals and (iv) advice offered after assessment was examined with a retrospective design. There was a significant decline in the number of referrals for each month across the three study phases exclusively accounted for by a decline between phase 2 and phase 3. The number of reasons for referral and management advice offered for social treatments per patient were greater in phase 1 compared to phase 2. The total number of management advice offered for medical treatments per patient was greater in phase 2 compared to phase 3. The cost of a specialist registrar attending a geriatric medicine ward round was more than offset by the associated decline in the number of referrals per month. Although this study was not designed as a cost-effectiveness study, the results suggest that the liaison component has the potential to be cost-effective. There is a need for more formal clinical effectiveness and cost-effectiveness studies in liaison geriatric psychiatry.