Abstract

Research Article

Proactive Psychiatric Consultation and Hospital Length of Stay in Adults: A Review of the Literature

Hathaway Chase, Haley Lauren, Irby Jonathan, Klumb Sydney and Cheng Johnny*

Published: 04 October, 2024 | Volume 8 - Issue 1 | Pages: 041-046

According to a 2022 systematic review on the prevalence of psychiatric disorders in general hospitals, it was estimated that approximately one-third of medical inpatients present with a coinciding psychiatric condition. However, other studies have reported that a low rate of patients actually obtain an inpatient psychiatric consult; and even fewer patients receive a consultation when it would not be traditionally indicated. Therefore, we have seen an emergence of the use of Proactive Consultation-Liaison (C-L) Psychiatry across many hospital settings. This model of care utilizes systematic screening for active mental health concerns, proactive interventions tailored to individual patients, team-based delivery, and care integration with primary services to provide psychiatric consultation earlier. This study conducted a focused PubMed search to review the research to date on proactive C-L psychiatry and its impact on hospital length of stay (LOS) in patients over 18 years old. Results show a consequential reduction in average hospital LOS when proactive C-L psychiatry services are used compared to reactive, on-request consultation services. A shortened LOS is seen with this practice when there is a quicker time for consultation or referral. Thus, there is evidence of proactive C-L psychiatry’s success in decreasing average hospital LOS and improving patient care. Additional studies are necessary to determine its significance, as little research to date has been completed on the topic. It is recommended to expand the scope of investigation to different patient populations, including but not limited to pediatrics and patients without an underlying mental health illness.

Read Full Article HTML DOI: 10.29328/journal.apmh.1001056 Cite this Article Read Full Article PDF

Keywords:

Proactive consultation-liaison psychiatry; Psychiatric disorders; Hospital Length of Stay (LOS); Mental health; Psychiatric services

References

  1. van Niekerk M, Walker J, Hobbs H, Magill N, Toynbee M, Steward B, et al. The prevalence of psychiatric disorders in general hospital inpatients: a systematic umbrella review. J Acad Consult Liaison Psychiatry. 2022;63(6):567-578. https://doi.org/10.1016/j.jaclp.2022.04.004
  2. Krautgartner M, Alexandrowicz R, Benda N, Wancata J. Need and utilization of psychiatric consultation services among general hospital inpatients. Soc Psychiatry Psychiatr Epidemiol. 2006;41(4):294-301. https://doi.org/10.1007/s00127-005-0025-z
  3. Pezzia C, Pugh JA, Lanham HJ, Leykum LK. Psychiatric consultation requests by inpatient medical teams: an observational study. BMC Health Serv Res. 2018;18(1):336. https://doi.org/10.1186/s12913-018-3171-1
  4. Oldham MA, Desan PH, Lee HB, Bourgeois JA, Shah SB, Hurley PJ, et al. Council on Consultation-Liaison Psychiatry. Proactive consultation-liaison psychiatry: American Psychiatric Association resource document. J Acad Consult Liaison Psychiatry. 2021;62(2):169-185. https://doi.org/10.1016/j.jaclp.2021.01.005
  5. Desan PH, Zimbrean PC, Weinstein AJ, Bozzo JE, Sledge WH. Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team. Psychosomatics. 2011;52(6):513-20. https://doi.org/10.1016/j.psym.2011.06.002
  6. Sledge WH, Gueorguieva R, Desan P, Bozzo JE, Dorset J, Lee HB. Multidisciplinary proactive psychiatric consultation service: impact on length of stay for medical inpatients. Psychother Psychosom. 2015;84(4):208-16. https://doi.org/10.1159/000379757
  7. Triplett P, Carroll CP, Gerstenblith TA, Bienvenu OJ. An evaluation of proactive psychiatric consults on general medical units. Gen Hosp Psychiatry. 2019;60:57-64. https://doi.org/10.1016/j.genhosppsych.2019.07.009
  8. Oldham MA, Chahal K, Lee HB. A systematic review of proactive psychiatric consultation on hospital length of stay. Gen Hosp Psychiatry. 2019;60:120-126. https://doi.org/10.1016/j.genhosppsych.2019.08.001
  9. Bronson BD, Alam A, Schwartz JE. The impact of integrated psychiatric care on hospital medicine length of stay: a pre-post intervention design with a simultaneous usual care comparison. Psychosomatics. 2019;60(6):582-590. https://doi.org/10.1016/j.psym.2019.05.004
  10. Chavez MA, Caplan JP, McKnight CA, Schlinkert AB, Chapple KM, Mankin JA, et al. Early psychiatric consultation is associated with decreased cost and length of stay in the patient population at a Level I trauma center. Cureus. 2021;13(8). https://doi.org/10.7759/cureus.17572
  11. Oldham MA, Lang VJ, Hopkin JL, Maeng DD. Proactive integration of mental health care in hospital medicine: PRIME medicine. J Acad Consult Liaison Psychiatry. 2021;62(6):606-616. Available from: https://doi.org/10.1016/j.jaclp.2021.06.005
  12. Triplett PT, Prince E, Bienvenu OJ, Gerstenblith A, Carroll CP. An observational study of proactive and on-request psychiatry consultation services: evidence for differing roles and outcomes. J Acad Consult Liaison Psychiatry. 2024;65(4):338-346. Available from: https://doi.org/10.1016/j.jaclp.2024.03.003
  13. Sharpe M, Walker J, van Niekerk M, Toynbee M, Magill N, Frost C, et al. HOME Study Team. Proactive integrated consultation-liaison psychiatry and time spent in hospital by older medical inpatients in England (The HOME Study): a multicentre, parallel-group, randomised controlled trial. Lancet Psychiatry. 2024;11(9):684-695. Available from: https://doi.org/10.1016/s2215-0366(24)00188-3
  14. Bui M, Thom RP, Hurwitz S, Levy-Carrick NC, O'Reilly M, Wilensky D, et al. Hospital length of stay with a proactive psychiatric consultation model in the medical intensive care unit: a prospective cohort analysis. Psychosomatics. 2019;60(3):263-270. Available from: https://doi.org/10.1016/j.psym.2018.07.011
  15. Sockalingam S, Alzahrani A, Meaney C, Styra R, Tan A, Hawa R, et al. Time to consultation-liaison psychiatry service referral as a predictor of length of stay. Psychosomatics. 2016;57(3):264-272. Available from: https://doi.org/10.1016/j.psym.2016.01.005
  16. Vulser H, Vinant V, Lanvin V, Chatellier G, Limosin F, Lemogne C. Association between the timing of consultation-liaison psychiatry interventions and the length of stay in general hospital. Br J Psychiatry. 2021;218(4):204-209. Available from: https://doi.org/10.1192/bjp.2019.233

Figures:

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?