Timing of referral to consultation-liaison psychiatry

The purpose of this study was to examine the factors affecting the timing of psychiatric consultations and the impact of timing on length of hospital stay. It also assessed the relationships between the timing of consultations and some clinical factors.

264 adult patients consecutively referred to the psychiatric C-L service at King Khaled University Hospital in Riyadh were prospectively included in 2004. The following information was recorded for each consultation: patient demographic characteristics, date of admission, date of consultation, date of discharge, total days of stay, specialty service requesting the consultation, reason for referral given by the referring physician, and DSM-IV diagnosis based on the consultation interview.

Earlier consultations significantly predicted shorter lengths of stay. Delayed consultations were seen with female patients, obstetrics/gynecology ward admission, patients perceived by their treating teams as having anxiety disorders or substance abuse, and psychiatric diagnoses of anxiety or bipolar affective disorder.

Timing of referral is a crucial variable for the effectiveness of psychiatric intervention in medical settings. Early detection strategies for high-risk patients with whom delayed consultation may occur, and increasing the awareness of nonpsychiatric physicians about the importance of timing of referral are very important for a better and cost-effective patient care. Further studies are also needed in this line of research.