TY - JOUR
T1 - Psychiatric consultation requests by inpatient medical teams
T2 - An observational study
AU - Pezzia, Carla
AU - Pugh, Jacqueline A.
AU - Lanham, Holly J.
AU - Leykum, Luci K.
N1 - Funding Information:
The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, and Health Services Research and Development Service (CDA 07–022). The funding body provided salary support for the investigators through the South Texas Veterans Health Care System and did not contribute to the research design or development of this manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veteran Affairs.
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/5/8
Y1 - 2018/5/8
N2 - 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.
AB - 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.
KW - Comorbidity
KW - Inpatient medicine
KW - Psychiatric consultation
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U2 - 10.1186/s12913-018-3171-1
DO - 10.1186/s12913-018-3171-1
M3 - Article
C2 - 29739414
AN - SCOPUS:85046670078
VL - 18
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 336
ER -