An Observational Study of Proactive and On-Request Psychiatry Consultation Services: Evidence for Differing Roles and...

Area of Science:

• Psychiatry
• Healthcare Management
• Health Services Research

Background:

• Proactive psychiatric consultation services expedite identification and assessment of medical inpatients requiring psychiatric care.
• These services may reduce hospital length of stay and improve staff satisfaction.
• Proactive and on-request services often coexist, necessitating an understanding of their distinct roles.

Purpose of the Study:

• To compare demographic and clinical data between contemporary proactive and on-request psychiatric consultation services.
• To analyze differences within a single academic medical center over a 4-year retrospective period using electronic medical records.

Main Methods:

• Retrospective analysis of electronic medical records.
• Comparison of patient demographics, clinical data, and service utilization between proactive and on-request psychiatric consultation services.
• Data collected over a 4-year period.

Main Results:

• Proactive services handled significantly more admissions (7592 vs. 1762) with shorter lengths of stay and faster initial psychiatric contact.
• Patients seen by proactive services were more likely to be female, Black, and publicly insured.
• On-request services managed patients with longer stays, more ICU/surgical involvement, and higher rates of in-hospital death or discharge to subacute rehabilitation.

Conclusions:

• Proactive and on-request psychiatric services serve complementary roles in inpatient care.
• Proactive services efficiently screen and treat a high volume of potentially underserved patients.
• On-request services provide crucial support for patients with complex needs, ensuring continuity of care.