Multidisciplinary Proactive Psychiatric Consultation Service: Impact on Length of Stay for Medical Inpatients

Sledge, William H.; Gueorguieva, Ralitza; Desan, Paul H.; Bozzo, Janis; Dorset, Julianne; Lee, Ho-Chang

doi:10.1159/000379757

Cited by 51 publications

(26 citation statements)

References 24 publications

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“…The studies by Orsak and colleagues (25) and Sledge and colleagues (26) evaluated proactive psychiatric consult liaison services in two different academic medical centers. In the study by Orsak, the intervention occurred on two hospitalist teams, and outcomes were compared to three hospitalist teams who continued to consult psychiatry in the traditional fashion.…”

Section: Resultsmentioning

confidence: 99%

“…Proactive psychiatric consultation, as studied by Orsak (25) and Sledge (26), may be able reduce psychotropic medication errors and delays, reduce agitation, and improve coordination with outpatient mental health providers, as proactive consultation has been found to reduce inpatient length of stay (26,45). Screening patients for depression or other mental health symptoms with validated tools during the inpatient hospital course, as studied by Jennings (27) and Huffman (34,35), also holds value.…”

Section: Discussionmentioning

confidence: 99%

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Effective mental health interventions to reduce hospital readmission rates: a systematic review

Benjenk¹,

Chen²

2018

J Hosp Manag Health Policy

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Background: Hospitals in the United States are financially penalized for having a higher than expected thirty-day readmission ratio among patients initially hospitalized for heart failure, acute myocardial infarction (AMI), pneumonia, chronic obstructive pulmonary disease (COPD), coronary artery bypass graft (CABG) surgery, or hip and knee replacement. Patients hospitalized for these conditions that have comorbid mental health diagnoses or symptoms are at high risk for readmission. Methods: We conducted a systematic review to determine if interventions, that are specifically designed to assess or treat mental health symptoms, can effectively reduce risk of readmission following hospitalization for physical health conditions. We searched on PubMed and Google Scholar for peer-reviewed articles published between January 2010 and June 2018 that examined the impact of mental-health interventions on readmissions for physical conditions. Results: After screening 81 full text articles, we found eleven intervention studies, one meta-analysis, and one cross-sectional study that met our inclusion criteria. Only three of the intervention studies found significant differences in readmission rates between intervention and comparison groups. Each of these interventions targeted patients after discharge from the hospital. One of the interventions was a physical health telemonitoring and individual psychotherapy intervention for patients that were initially admitted for heart failure. The second intervention was individual and group psychotherapy sessions for patients who were initially admitted for AMI. The third intervention was a nurse-driven depression care management protocol for home care patients with depressive symptoms who were initially admitted for any physical health condition. The cross-sectional study showed that communities with a stronger, social-based public mental health infrastructure had significantly lower physical health readmission rates. Conclusions: The literature identified in this review, appears to provide support for the use of mental health interventions after discharge as a mechanism for reducing physical health condition readmissions. Future research is needed to determine if these interventions can specifically reduce thirty-day readmissions for the six conditions linked to financial penalties.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effective mental health interventions to reduce hospital readmission rates: a systematic review

Benjenk¹,

Chen²

2018

J Hosp Manag Health Policy

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“…In particular, the LOS was reduced by 23.7% (9 days) in the pilot study of Desan et al conducted in the United States . Furthermore, it has also been shown that people receiving a proactive psychiatric consultation compared to the conventional liaison service had a significantly shorter hospitalization . Another approach to improve care for PWD hospitalized for acute somatic illness could be special care units …”

Section: Discussionmentioning

confidence: 99%

“…77 Furthermore, it has also been shown that people receiving a proactive psychiatric consultation compared to the conventional liaison service had a significantly shorter hospitalization. 78 Another approach to improve care for PWD hospitalized for acute somatic illness could be special care units. 79 An additional explanation for a longer LOS among PWD may be the functional and cognitive decline during hospitalization, 80 which could prevent PWD from expressing their complaints to the medical staff including the occurrence of adverse drug reactions 31,[81][82][83] occurring in up to 11% of the hospital admissions.…”

Section: Los In Hospitalizations Due To Infectious Cardiovascularmentioning

confidence: 99%

Length of hospital stay and dementia: A systematic review of observational studies

Möllers

Stocker

Wei

et al. 2018

Int J Geriat Psychiatry

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Objective Hospitalizations of people with dementia (PWD) are often accompanied by complications or functional loss and can lead to adverse outcomes. Unsystematic findings suggest an influence of comorbidities on the extent of differences in the length of hospital stay (LOS). This systematic review aimed to identify and evaluate all studies reporting LOS in PWD as compared to PwoD in general hospitals. Methods A systematic review of observational studies using PubMed and ISI Web of Knowledge. Inclusion criteria comprised original studies written in English or German, assessment of diagnosis of dementia, measurement of LOS, and comparison of people with and without dementia. Results Fifty‐two of 60 studies reported a longer hospitalization time for PWD compared to PwoD. The extent of the difference in LOS varied between and within countries as well as by type of primary morbidity (eg, injuries, cardiovascular diseases). The range of the LOS difference for studies without restriction to a primary morbidity was −2 to +22 days after matching or adjustment for a variable number and selection of potentially relevant covariates. For studies with injuries/fractures/medical procedures and infectious/vascular disease as the primary morbidity, the range was −2.9 to +12.4 and −11.2 to +21.8 days, respectively. Conclusions The majority of studies reported a longer hospitalization of PWD compared to PwoD. Length of hospital stay seems to be influenced by a variety of medical, social, organizational factors, including reasons for hospital admission, whose role should be explored in detail in further research.

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“…Specific geriatric and pediatric psychiatric consultation services are also available [211,212]. The existing literature indicates that the goals of consultation-liaison psychiatry (reducing the length of hospitalization and utilization of laboratory tests, providing an input on patient management, and improving social functioning after discharge) can be met, even though results considerably differ across studies [210,213,214]. Developments of consultation-liaison psychiatry are hindered by its modalities of assessment and treatment that follow a reductionist (psychiatric) paradigm, missing psychosocial perspectives and correlates that may affect the response to medical treatments [215,216].…”

Section: Multidisciplinary Carementioning

confidence: 99%

Current Psychosomatic Practice

Fava

Cosci²,

Sonino³

2016

Psychother Psychosom

252

317

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Psychosomatic research has advanced over the past decades in dealing with complex biopsychosocial phenomena and may provide new effective modalities of patient care. Among psychosocial variables affecting individual vulnerability, course, and outcome of any medical disease, the role of chronic stress (allostatic load/overload) has emerged as a crucial factor. Assessment strategies include the Diagnostic Criteria for Psychosomatic Research. They are presented here in an updated version based on insights derived from studies carried out so far and encompass allostatic overload, type A behavior, alexithymia, the spectrum of maladaptive illness behavior, demoralization, irritable mood, and somatic symptoms secondary to a psychiatric disorder. Macroanalysis is a helpful tool for identifying the relationships between biological and psychosocial variables and the individual targets for medical intervention. The personalized and holistic approach to the patient includes integration of medical and psychological therapies in all phases of illness. In this respect, the development of a new psychotherapeutic modality, Well-Being Therapy, seems to be promising. The growth of subspecialties, such as psychooncology and psychodermatology, drives towards the multidisciplinary organization of health care to overcome artificial boundaries. There have been major transformations in health care needs in the past decades. From psychosomatic medicine, a land of innovative hypotheses and trends, many indications for changes in the current practice of medicine are now at hand. The aim of this critical review is to outline current and potential clinical applications of psychosomatic methods.

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Multidisciplinary Proactive Psychiatric Consultation Service: Impact on Length of Stay for Medical Inpatients

Cited by 51 publications

References 24 publications

Effective mental health interventions to reduce hospital readmission rates: a systematic review

Effective mental health interventions to reduce hospital readmission rates: a systematic review

Length of hospital stay and dementia: A systematic review of observational studies

Current Psychosomatic Practice

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