Effect of Timing of Psychiatry Consultation on Length of Pediatric Hospitalization and Hospital Charges

Abstract

Objectives: The purpose of this study was to evaluate the impact of timing of a psychiatry consultation during pediatric hospitalization on length of hospital stay and total hospitalization charges. Methods: The charts of 279 pediatric patients (totaling 308 consultations) referred to the psychiatry consultation liaison service at a freestanding tertiary pediatric hospital between January 1, 2010, and June 30, 2010 were retrospectively analyzed. The variables analyzed included the following: patient demographic characteristics; dates of admission, psychiatric consultation, and discharge; psychiatric diagnoses based on the psychiatric diagnostic evaluation; psychiatric treatment disposition; and illness severity and total charges associated with the medical stay. Results: Earlier psychiatry consultation was associated with shorter length of stay and lower hospitalization charges after adjusting for psychiatric functioning, physical illness severity, and psychiatric disposition. Poorer psychiatric functioning and milder physical illness were associated with shorter referral time. Conclusions: Timely involvement of psychiatry consultation services during a medical or surgical hospitalization was associated with reductions in length of stay and total hospital charges in pediatric settings. These findings have important effects on quality of care via decreasing burden on the patient and family and on the medical system resources. Educating pediatric health care providers about the importance of early psychiatry consultation regardless of physical illness severity or psychiatric acuity will likely improve resource management for patients and hospitals.

Medically Hospitalized Patients With Eating Disorders and Somatoform Disorders in Pediatrics: What Are Their Similarities and Differences and How Can We Improve Their Care?

“…A recent pediatric study revealed that earlier referral to psychiatry consultation-liaison services for patients with a wide array of diagnoses, including SFD and ED, resulted in shorter lengths of stay and lower hospital charges regardless of illness severity. 7 From an evidence-based treatment perspective, randomized controlled trials have identified family-based therapy and cognitive behavioral therapy as effective outpatient treatments for ED and SFD patients, respectively 31,32 ; however, there is a lack of studies regarding effective psychosocial treatment approaches that can be implemented for patients with ED or SFD during medical admissions. With average admission lengths of .1 week for ED patients and close to 5 days for SFD patients, our study highlights opportunities for brief psychosocial interventions in the hospital setting that can improve health outcomes and reduce recurrent hospitalizations and emergency department visits.…”

“…5 Patients with SFD constituted 13% of medically hospitalized youth seen by an inpatient psychiatric consultation service at a free-standing children' s hospital in 2010 and 2011 6 and were the third most common referral (anxiety and depressive diagnoses being the most common). 7 Admission to the hospital is associated with greater functional impairment compared with the outpatient setting, 4,6 and inpatient pediatric mental health has been identified as a priority area for national quality measurement and improvement. 1,8 Understanding the characteristics of patients with primary psychiatric disorders like ED and SFD, who are often medically hospitalized in pediatric settings, is the first step toward establishing foundational knowledge to guide future quality improvement and integrated care efforts.…”

Opportunities to Improve Inpatient Care for Children With Behavioral Comorbidities

“…4,10 Access to an inpatient psychiatric consultative service leads to improved patient outcomes, shorter LOS with resultant decreased hospital costs, and family satisfaction. 17,18 However, this service is not widely available, underscoring the importance of inpatient provider communication with primary care physicians, outpatient mental health care providers, and parents and caretakers. Partnering with a provider that has a long-standing relationship with a child can provide great insight into what has previously been effective, common triggers; how to best manage behavioral and psychiatric complaints; and what the patient' s baseline level of functioning is so as to better adapt the hospital experience to that baseline.…”

Evaluation of Child and Adolescent Psychiatry Consultations

“…Eþlik eden ruhsal bozukluk, hastada iþlevselliðin daha fazla bozulmasýna, hastanede yatýþ süresinin uzamasýna, morbidite ve mortalitenin artmasýna neden olmaktadýr (7). Hem ülkemizde hem de diðer ülkelerde yatan hastalardaki psikyatrik rahatsýzklýklarýn tanýnmasý ve tedavisi konusunda kýsýtlýlýklar vardýr.…”