Tuesday, October 1, 2019

Use of Consultation-Liaison Psychiatry May Reduce Hospital Patients’ Length of Stay

The use of proactive consultation-liaison psychiatry, along with clinically informed screening and integrated mental health care delivery, appears to help reduce patients’ average length of stay in the hospital, according a report in General Hospital Psychiatry.

“The unmet need for psychiatric care in the general hospital is substantial and compromises the quality and delivery of care,” wrote Mark Oldham, M.D., of the University of Rochester Medical Center and colleagues. “Proactive mental health screening offers an opportunity for timely identification and clinical attention to improve outcomes.”

Researchers systematically reviewed studies from Pubmed, Embase, PsycINFO, and Cochrane Library published through May 2019, seeking studies that examined how early mental health screening of hospitalized adults impacted patients’ length of stay. Though initially yielding 738 results, only 12 studies were included in the systematic review after researchers “evaluated the level of evidence and defined the study sample, means of group allocation, screening process, interventions, and outcomes.”

The studies used various screening and intervention methods for patients. In some, psychiatrists met with all patients in a given setting, such as after hip fracture surgery, while in others, patients were identified using standardized instruments as needing mental health care. In most studies, the intervention “was a formal psychiatric consultation by services variously staffed by psychiatrist, trainees, nurses, and research personnel.”

Most of the studies reported reduced length of stay for patients; two studies also reported “favorable returns on investment that more than offset the increased costs of providing this level of enhanced care,” Oldham and colleagues wrote. While the authors noted that “the heterogeneity across study designs makes it difficult to attribute this to any one study element in isolation,” they added that three interrelated elements of each of the studies appear to be tied to positive outcomes: “screening that draws upon mental health care expertise, integrated care delivery, and unit- or service-level analysis.”

“All studies investigating models wherein care delivery was integrated with primary services—either as embedded psychiatrists or multidisciplinary team-based care—reported either a statistical reduction in LOS [length of stay] or a trend in favor of reduced LOS,” they wrote.

For more information, see the Psychiatric News article “The Role of C-L Psychiatrists in Caring for Cardiac Patients.”

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