No abstract

Advances in information technology now permit clinically significant events that take place during "off hours" to be identified and reported (via handoff) to next providers and to supervisors via collated reports. This information permits hospital leaders to correct safety issues quickly and effectively, while attending physicians are able to use information gleaned from the reports to optimize rounding plans and to provide additional oversight of trainee on call patient management decisions.

The evolving complexity of comorbidity of medical illness and mental illness in the context of a changing economy and public policy was noted in the American Psychological Association Presidential Address in 2010 [1]. The address emphasized that professionals in the field of psychology needed to shift their training and focus to a multidisciplinary and integrative approach. In line with this emphasis, our university counseling center identified the need to redesign the system of mental health care on campus.Our counseling center was independent of psychiatric assessment and treatment of students until 2011, at which time individuals trained in psychiatry joined the staff of individuals trained in psychology, social work, and professional counseling. In summer 2012, a child and adolescent psychiatrist was hired as the director of the center to restructure the services. The director identified gaps in communication between medical and therapy providers. A reliance on individual therapy as the treatment modality for all students resulted in the need for services exceeding the available appointment times. The director organized a leadership team tasked with redesigning the system. The team included a psychologist trained in university counseling and an outreach, education, and prevention coordinator with advanced knowledge in education and counseling. This report highlights the use of a clinical case conference to facilitate the development of multidisciplinary treatment plans designed to diversify services, thereby increasing access for students and improving communication among disciplines in a university mental health clinic. University mental health system studies in the past two decades have documented an increase in severity of presenting complaints at university counseling centers [2, 3]. They emphasized a need to shift care toward a "mental health clinic" model [2].Kettmann et al.[3] reviewed the perception that student acuity has increased in university counseling centers and identified an increase in the complexity of the students seen in university counseling centers, leading to greater service utilization by a subset of students served by the centers. He concluded that counseling centers need a system in which the complexity of students with multiple diagnoses is acknowledged through the development of a range of therapeutic modalities beyond the traditional individual therapy model.Our university counseling center has experienced similar challenges in our efforts to support students who present with multiple diagnoses and complex treatment needs. We anchored our system design to an educational case conference to guide the multidisciplinary staff toward an integrative model that incorporates evidence-based practice for a broad range of clinical presentations. The structure supports a team consultation model that facilitates care of complex students and supports review of resources leading to clinical program development and design of programs for education and prevention on campus. The case conference has...

1170] Figure 1. Forest plots for rate of (A) portal vein thrombosis (PVT) recanalization, (B) bleeding events, and (C) all-cause mortality following use of anticoagulation as therapy for PVT in the setting of cirrhosis.