Psychiatric Consultation Service Research Articles

An Observational Study of Proactive and On-Request Psychiatry Consultation Services: Evidence for Differing Roles and Outcomes

BackgroundProactive psychiatric consultation services rapidly identify and assess medical inpatients in need of psychiatric care. In addition to more rapid contact, proactive services may reduce length of stay, and improve staff satisfaction. However, it is in some settings impractical to integrate a proactive consultation service into every hospital unit; on-request and proactive services are likely to coexist in the future. Prior research has focused on changes in outcomes with implementation of proactive services. Objectives and MethodsThis report describes differences between contemporary proactive and on-request services within the same academic medical center, comparing demographic and clinical data collected retrospectively from a four-year period from the electronic medical record (EMR). ResultsThe proactive service saw patients over four times as many initial admissions (7592 vs 1762), but transitions and handoffs between services were common, with 434 admissions involving both services, comprising nearly 20% of the on-request service’s total contacts. The proactive service admissions had a shorter length of stay, a faster time to first psychiatric contact, and patients seen were more likely to be female, of Black race and to be publicly insured. There were over three times as many admissions to psychiatry from the proactive service. The on-request service’s admissions had a longer length of stay, were much more likely to involve ICU services, surgical services, and transfers among units; and the patients seen were more likely to die in the hospital or to be discharged to subacute rehabilitation. ConclusionsOverall, the results suggest that the two services fulfill complementary roles, with the proactive service’s rapid screening and contact providing care to a high volume of patients who might otherwise be unidentified and underserved. Simultaneously, the on-request service’s ability to manage patients in response to consult requests over a much larger area of the hospital provided important support and continuity for patients with complex health needs. Institutions revising their consultation services will likely need to consider the best balance of these differing functions to address perceived demand for services.

Evaluation of a psychiatric pharmacist consultation service in a multispecialty outpatient clinic

AbstractBackgroundIntegrated care programs provide both medical and mental health care in clinical settings. Psychiatric pharmacists play a key role in optimizing patient care when integrated into a healthcare team. This project describes the implementation and trends of a psychiatric pharmacist consultation service in a multispecialty outpatient through an integrated behavioral healthcare model.MethodsThis is a retrospective study analyzing a psychiatric pharmacist consultation service at an academic multispecialty outpatient clinic. Eligible patients were aged ≥17 years and seen by the psychiatric pharmacist between June 1, 2019 and June 30, 2022. Patient demographics, reasons for referral, and pharmacist interventions were collected. Patient outcomes on depression, anxiety, and diabetes were also explored. Descriptive statistics were used to quantify information.ResultsA total of 572 encounters were identified. Of those, 285 (49.8%) represented unique patients. Over the 36‐month period, an average of 16 consults were conducted per month. Anxiety and depressive disorders, pain syndromes, and adult attention‐deficit/hyperactivity disorder were the most common diagnoses listed as reasons for consultation. An average of five recommendations or interventions were provided by the psychiatric pharmacist at each initial consultation. Anxiety and depression symptom scores, as well as hemoglobin A1c (HbA1c) values, were lower following pharmacist consultation.ConclusionPsychiatric pharmacists can serve a unique role at multispecialty clinics by providing consultation for patients with psychiatric conditions, chronic pain, medical conditions, and polypharmacy. This study demonstrates the successful utilization of such a service and suggests a psychiatric pharmacist's expertise contributes to improved depression, anxiety, and glycemic outcomes. The multispecialty outpatient setting represents an opportunity to further explore growth for psychiatric pharmacists and the impact these services have on patient outcomes.

(069) Studying Inequities in Utilization of Psychiatric Consultation Services in a Women's Health Hospital

(069) Studying Inequities in Utilization of Psychiatric Consultation Services in a Women's Health Hospital

(169) Streamlining Handoffs: Implementing an Improved Care Transition Support Tool on an Inpatient Psychiatric Consultation Service

(169) Streamlining Handoffs: Implementing an Improved Care Transition Support Tool on an Inpatient Psychiatric Consultation Service

Psychiatric consultation: Characteristics, satisfaction, and perceived opportunities among referrers to a 1-time service.

To further understand and optimize primary care provider (PCP) referrals to a 1-time psychiatric consultation service by developing profiles of PCP referrers, assessing PCP satisfaction with the service, and determining intervention opportunities. Secondary analysis of a referral database and subsequent cross-sectional survey of referrers. Winnipeg, Man. All family physicians who had made at least 1 referral in 2017 to the Centralized Psychiatric Consultation Service for Adults, a 1-time consultation service. Referral frequency, individual and practice characteristics, satisfaction with the Centralized Psychiatric Consultation Service for Adults, and subjective drivers of referral activity were assessed. Interest in a range of intervention opportunities to increase mental health knowledge and support were also examined. Of the 403 family physicians who referred patients to the consultation service in 2017, a total of 111 (27.5%) responded to the survey. Among all referrers, 287 (71.2%) were low referrers (1 to 4 referrals), 65 (16.1%) were moderate referrers (5 to 9 referrals), and 51 (12.7%) were high referrers (≥10 referrals). Solo practice (P=.04) and no access to collaborative mental health services (P<.001) were significantly associated with being a high referrer. Roughly 26.3% of low referrers, 29.2% of moderate referrers, and 15.4% of high referrers were satisfied with wait times for the service. Higher referrers did not identify a lack of comfort with providing psychiatric care as a driver of referrals; more indicated that they had a high volume of patients with mental health needs, that there was a lack of access to alternative services, and that patients sometimes requested referral. Overall, more than 40% of respondents expressed interest in a mental health care navigator, hard-copy resource information, and rapid access to consultation advice via telephone or an electronic platform. There was less interest in other proposed interventions. We found referrers to the Centralized Psychiatric Consultation Service for Adults to be clustered based on specific practice characteristics, as well as provider-patient factors. Overall, satisfaction with the service was fair and PCPs were not highly interested in a variety of proposed interventions. Future studies should explore how useful 1-time consultation services are for solo-practising PCPs and how best to support these and other PCPs in their management of patients with mental health needs.

Financial Abuse of Older Adults: Screening, Prevention, and Interventions by Primary Care Providers.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion. 2023;25(3):22f03434.Author affiliations are listed at the end of this article.

Cost of Implementing an Evidence-Based Intervention to Support Safer Use of Antipsychotics in Youth.

To estimate the cost of implementing a clinical program designed to support safer use of antipsychotics in children and adolescents (youth) age 3-17years at the time of initiating an antipsychotic medication. We calculate the costs of implementing a psychiatric consultation and navigation program for youth prescribed antipsychotic medications across 4 health systems, which included an electronic health record (EHR) decision support tool, consultation with a child and adolescent psychiatrist, and up to 6months of behavioral health care navigation, as well as telemental health for patients (n = 348). Cost data were collected for both start-up and ongoing intervention phases and are estimated over a 1-year period. Data sources included study records and time-in-motion reports, analyzed from a health system perspective. Costs included both labor and nonlabor costs (2019 US dollars). The average total start-up and ongoing costs per health system were $34,007 and $185,174, respectively. The average total cost per patient was $2,128. The highest average ongoing labor cost components were telemental health ($901 per patient), followed by child and adolescent psychiatrist consultation ($659), and the lowest cost component was primary care/behavioral health provider time to review/respond to the EHR decision support tool and case consultation ($24). For health systems considering programs to promote safer and targeted use of antipsychotics among youth, this study provides estimates of the full start-up and ongoing costs of an EHR decision support tool, psychiatric consultation service, and psychotherapeutic services for patients and families.Trial registration: Clinicaltrials.gov, NCT03448575.

Drug-Induced Abnormal Involuntary Movements: Prevalence and Treatment.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Use of Physical Restraints in the Emergency Department

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Utilization Pattern of Psychiatric Consultation Services at the University of the Philippines-Philippine General Hospital (UP-PGH) from 1999-2008

Objective. This study describes the utilization pattern of psychiatric consultation services at the UP-PGH from 1999 – 2008 by reviewing the demographic data of patients referred, describing the Axis I (Clinical Disorders and Other Disorders That May Be a Focus of Clinical Attention) and Axis III (General Medical Conditions) diagnoses of referred patients, and by identifying the sources of, and reasons for the different referrals.&#x0D; Methods. Relevant data from the annual census of the Consultation – Liaison (CL) Psychiatry Section from 1999 – 2008 was reviewed according to age, sex, civil status, reasons for referral, DSM-IV TR Multi-axial diagnoses and sources of referrals.&#x0D; Results. The percentage of referrals to consultation psychiatry has increased from 1.03% in 1999 to 1.77% in 2008. There is equal distribution between males and females. Majority of the consultation referrals were married and belonged to the 21-40 age group. The top five referring services were general medicine, surgery and trauma, obstetrics-gynecology, otorhinolaryngology and orthopaedic departments. The top three reasons for referring patients were mood problems, agitation and restlessness, and suicide attempts/behaviour. Majority of the axis I diagnoses were adjustment disorder, depressive disorders, and psychological reactions to illness. According to Axis III diagnoses, majority of the referrals were associated with poisoning and injury, neoplasms, and endocrine, nutritional, metabolic and immunity disorders.&#x0D; Conclusion. The referral rate to the CL-Psychiatry Section at the UP-PGH has increased throughout the period studied. This may be attributed to programs and activities that improve efficiency in the delivery of psychiatric knowledge and skills, and better personnel supervision. The referral rate of 1.03% to 1.82% was consistent with those in other countries.

Perinatal psychiatric practitioner consultation program delivers rapid response to OB/GYN practitioners.

Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly evolving. Practitioner-to-psychiatrist consultation programs have the potential to improve the management of psychiatric conditions in perinatal women. This study describes utilization of a statewide perinatal psychiatric consultation service by OB/GYN practitioners through examination of the volume, responsivity, content and outcomes of clinical inquiries, and satisfaction. This quality improvement study describes the 460 telephone or e-mail consultations requested by OB/GYN practitioners over 2 years and housed within a REDCap database. Data include the characteristics of consult users, month-over-month and total utilization, the patient's perinatal status, the reason for contact, current symptoms and medications, and the consulting psychiatrist recommendations. Practitioner satisfaction with consultation is also described. After completion of triage, the psychiatrist returned the practitioner's call ≤5min in 59% of consultations. The most common inquiries were for pregnant (64%) women for depressive (51%) or anxiety (46%) symptoms with 47% of inquiries reporting the patient was currently taking a psychiatric medication. Had consultation not been available, referral to mental health (41%) or starting a medication (15%) were most often reported. This perinatal psychiatric consultation service rapidly and effectively met the needs of practitioners practicing in OB/GYN settings across a state having a critical psychiatry shortage and varying urban and rural geography. Future recommendations include the assessment of direct patient outcomes, practitioner skill attainment, and long-term cost savings of this perinatal psychiatric consultation model.

Assessment and Management of Delirium in Pediatric Patients

LESSONS LEARNED AT THE INTERFACE OF MEDICINE AND PSYCHIATRY The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Drug Safety Profiles of Geriatric Patients Referred to Consultation Psychiatry in the Emergency Department-A Retrospective Cohort Study.

Geriatric patients account for a significant proportion of the collective treated by psychiatric consultation service in hospitals. In the Emergency Department (ED), psychotropic drugs are frequently recommended, notwithstanding their extensive side-effect profiles. This study sought to investigate medication safety of geriatric patients referred to psychiatric consultation service in the ED. Medication lists of 60 patients from the general internal medicine and trauma surgery EDs referred to psychiatric consultation service were analyzed. Utilizing PRISCUS list and Fit fOR The Aged (FORTA) classification, prescriptions of potentially inappropriate medications (PIMs) were assessed. 84 drugs were newly prescribed following psychiatric consultations. The total number of drugs per patient was 5.4 ± 4.2 before psychiatric consultation and 6.5 ± 4.2 thereafter (p < .001). 22.6 % of the newly recommended drugs were PIMs according to the PRISCUS list, while 54.8 % were designated as therapeutic alternatives to PIMs. 54.8 % and 20.2 % of the newly recommended drugs were FORTA category C and D drugs, respectively. An average of 1.2 ± 1.7 drug-drug interactions (DDIs) existed before psychiatric consultation and 1.3 ± 1.9 DDIs thereafter (p = .08). The majority of newly recommended drugs by psychiatric consultation service in the ED were designated as suitable therapeutic alternatives to PIMs according to the PRISCUS list, but had comparatively unfavorable ratings according to the FORTA classification, demonstrating discrepancies between these two PIM classification systems. Physicians delivering psychiatric consultation services in the ED should not solely rely on one PIM classification system.

Agitation and an Altered Mental Status in the Emergency Department: Differential Diagnosis, Evaluation, and Treatment.

LESSONS LEARNED AT THE INTERFACE OF MEDICINE AND PSYCHIATRY The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Diagnosis and Management of Hypertensive Emergency in a Patient With Generalized Anxiety Disorder.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

12.2 Telepsychiatry Expansion Supporting Psychiatric Consultation and Inpatient Psychiatric Services at Children’s Hospital Colorado During the COVID-19 Pandemic

The aims of this presentation are to: 1) briefly describe the many barriers to in-person psychiatric consultation and care during the pandemic; 2) describe innovative teleconsultative services afforded to emergency department (ED) and inpatient settings at a large, tertiary care pediatric hospital; and 3) describe an innovative tele-based service for COVID-19–positive patients requiring inpatient psychiatric hospitalization at a large, tertiary care pediatric hospital.

3.80 Pediatric Telephonic Psychiatric Consultation for Early Childhood and Infant Mental Health

In response to limited access to child and adolescent psychiatrists, Children’s Telephonic Psychiatric Consultation Service (TiPS) provides real-time consultation to primary care providers (PCPs) for pediatric patients with mental health (MH) concerns. It is estimated that 8% to 10% of children younger than 6 years old (yo) experience clinically significant MH problems, yet access lines have typically focused on older children. Our objective is to characterize pediatric telephone consultation for this younger group.

40.4 A Systems of Care Response to the Pediatric Mental Health Patient Surge: Creation of a Pediatric Psychiatric Consult Service to the Emergency Department and a Bridge Clinic

This presentation will describe the impact of a pediatric psychiatric consult service (PPCS) to the emergency department (ED) and a bridge clinic on the pediatric mental health patient surge and boarding crisis. There will also be a discussion about how the bridge clinic functioned in providing a hospital system alternative for some pediatric crisis patients and its impact on the boarding crisis.

Neuropsychiatric symptoms in the psychiatric counseling of patients admitted with COVID-19 infection

BackgroundCovid-19 patients suffer from psychiatric disorders too. The present study was designed to investigate the rate of psychiatric consultation requests in a general hospital. Reasons for consultation requests, types of psychiatric diagnoses, and factors in consultation requests were also investigated. MethodsThis cross-sectional study included all patients admitted with Covid-19 and referred to psychiatric consultation service in a major Covid-19 center in Tehran, Iran (2020). After acceing patients’ electronic files, records of patients’ demographic information, positive psychiatric symptoms, past psychiatric history and DSM5 diagnoses were made. Statistical analyses were done in SPSS 26 using descriptive statistics and chi-square and Fisher's exact test (p<0.05). ResultsOut of 1791 Covid-19 hospitalized patients, 132 patients (7.3%) had been referred to psychiatric consultation service. The most common reason for requests were restlessness and aggression (23.5%). Meanwhile, 92.4% of the patients were diagnosed to suffer from at least one psychiatric disorder including insomnia (64%), delirium (30.3%), anxiety due to hypoxia (15.3%) and generalized anxiety disorder (10.6%). ConclusionAlthough studies report a high prevalence of psychiatric disorders in Covid-19 patients, requests for psychiatric consultations and consideration of psychiatric disorders are still remarkably low. The most common disorders appeared to be insomnia, delirium and anxiety.

Recognizing and Addressing Health Care Disparities Among Black Populations.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.