Psychiatric consultation requests by inpatient medical teams: An observational study

Carla Pezzia, Jacqueline A Pugh, Holly L Lanham, Luci K Leykum

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: We describe the way psychiatric issues are addressed by inpatient medical teams through analysis of discussions of patients with behavioral health concerns and examination of teams' subsequent consultation practices. Methods: We observed morning rounds for nine inpatient medical teams for approximately month-long periods, for a total of 1941 observations. We compared discussions of patients admitted for behavioral health related medical conditions between those who did and did not receive a psychiatric consultation, developing categories to describe factors influencing consultation or other management. Results: Out of 536 patients, 40 (7.5%) received a psychiatry consult. Evaluation of a known concern (i.e., substance use, affective disorder, or suicidal ideation) was the most common reason for referral (41.7%). Requests for medication review were second (30.6%). Thirty patients with concomitant behavioral and medical health issues did not receive a psychiatry consult. Cirrhosis with active substance use was the most common medical diagnosis (15), followed by alcohol withdrawal (9). Conclusions: Four primary themes emerged from our data: positive identification of behavioral health issues by physicians, medication management as a primary reason for referral, patient preference in physician decision-making, and poor management of substance abuse. Our results identify two potential areas where skills-building for inpatient physicians could have a positive impact: management of medication and of substance abuse management.

Original languageEnglish (US)
Article number336
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
StatePublished - May 8 2018

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Keywords

  • Comorbidity
  • Inpatient medicine
  • Psychiatric consultation

ASJC Scopus subject areas

  • Health Policy

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