Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study

Abstract

Objective: This study aimed to describe the provision of consultation-liaison psychiatry (CLP, also known as liaison psychiatry) services in acute hospitals in Ireland, and to measure it against recommended resourcing levels.Methods: This is a survey of all acute hospitals in Ireland with Emergency Departments, via an electronic survey sent by email and followed up by telephone calls for missing data. Data were collected on service configuration, activity, and resourcing. Data were collected from CLP or proxy services at all acute hospitals with an Emergency Department in Ireland (n = 29). This study measured staffing and activity levels where available.Results: None of the services met the minimum criteria set out by either national or international guidance per 500 bed general hospital.Conclusions: CLP is a relatively new specialty in Ireland, but there are clear international guidelines about the staffing levels required to run these services safely and effectively. In Ireland, despite clear national guidance on staffing levels, no services are staffed to the levels suggested as the minimum. It is likely that patients in Ireland's acute hospitals have worse outcomes, and hospitals have unnecessary costs, due to this lack. This is the first study of CLP provision in Ireland and demonstrates the resource constraints under which most services work and the heterogeneity of services nationally.

Evaluation of consultation liaison psychiatry in Australian public hospitals (AU-CLS-1)

“…This finding is similar to studies in New Zealand and the UK. [8][9][10] It supports the notion that CLS are inadequately resourced to provide the minimum needs for patients admitted to Australian hospitals, with likely consequences on patient flow and quality of care. Deficiencies in metropolitan services are overshadowed by the dearth of CLS in regional and rural services.…”

Discharged from the emergency department following hospital-presented self-harm: referral patterns and risk of repeated self-harm

“…However, in some acute hospitals in the country, there is no onsite psychiatry cover out of normal working hours. Where out-of-hour cover is provided, it is the responsibility of on-call psychiatry trainees on a short-term rotation, with access to supervision from an on-call consultant [22]. Thus, the importance of providing regular training in the assessment and care of selfharm patients to non-consultant hospital doctors is of the utmost importance to achieve high quality care out of hours.…”

Broadening the state of play – the second national survey of Consultation-Liaison Psychiatry services in New Zealand, 2021

“…Benchmarking CLP services by staffing levels is fraught with difficulty given that variations in service models, hours of operation, coverage of patient groups, sizes of hospitals and levels of activity make any comparison of services analogous to comparing apples and oranges. With that caveat, comparisons (see Tables 6 and 7) of CLPSNZ-2 with four recent western European national CLP surveys, 3,[6][7][8] a recent Australian survey (AUCLS-1), 4 and the published minimum staffing levels for England 5,9 and Australia 10 reveal just how under-resourced CLP services in NZ are (0.26 psychiatrist FTE and 1.10 clinician FTE per 100 inpatient beds).…”