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Proactive Psychiatry: Innovating the Delivery of Consultation-Liaison Services in a Pediatric Hospital
Elizabeth Schindler1, Katherine Winner1, Ramzi W Nahhas2
1Department of Psychiatry, Dayton Children's Hospital, Dayton, OH; Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Fairborn, OH.
Insights
A proactive consultation-liaison psychiatry service in pediatric hospitals reduced length of stay (LOS) compared to no consults or reactive consults. This model also improved hospitalist satisfaction and recommendation concordance.
Area of Science:
- Pediatric Psychiatry
- Consultation-Liaison Services
- Healthcare Management
Background:
- Consultation-liaison psychiatry services are proven beneficial for adults, reducing length of stay (LOS) and enhancing care.
- Limited research exists on the effectiveness of proactive consultation-liaison psychiatry in pediatric settings.
- This study addresses the gap by evaluating a proactive model in pediatric hospitals.
Purpose of the Study:
- To compare the effectiveness of a proactive psychiatry consult service with concurrent (no consult) and historical reactive consults in pediatric patients (aged 5-18).
- To assess the impact on hospital length of stay (LOS), patient satisfaction, hospitalist satisfaction, and recommendation concordance.
Main Methods:
- A prospective study comparing proactive consults (n=65) to concurrent controls (n=63) and reactive historical controls (n=45) on general medical floors.
- Adjusted negative binomial regression was used to analyze hospital LOS.
- Secondary outcomes included patient and hospitalist satisfaction, and recommendation concordance.
Main Results:
- Proactive consults were associated with a significantly lower LOS compared to historical reactive consults (twice as long) and a trend towards lower LOS than concurrent controls (14% longer).
- Patient satisfaction scores were modestly more favorable for proactive consults, though response rates were low.
- Hospitalist satisfaction surveys showed statistically significant improvements after the introduction of the proactive service.
- Recommendation concordance was higher for proactive consults, particularly for diagnoses and non-medication recommendations.
Conclusions:
- A proactive consultation-liaison psychiatry model positively impacts pediatric care.
- This model is associated with reduced hospital LOS, improved hospitalist satisfaction, and enhanced recommendation concordance in pediatric hospitals.
- The findings support the implementation of proactive consultation-liaison psychiatry services in pediatric settings.
Background:
The benefits of a proactive consultation-liaison psychiatry service have been well documented in the adult population, including decreased length of stay (LOS), increased satisfaction among physicians, and enhanced collaborative care. However, there is no available research on the effectiveness of this model in pediatric hospitals.
Objective:
This study compared patients aged 5-18 years on a general medical floor receiving a proactive psychiatry consult to concurrent controls receiving no consult and to historical controls receiving traditional reactive consults.
Methods:
New admissions to two pediatric general medical hospital teams were reviewed on weekday mornings to identify those with active psychiatric concerns. Adjusted negative binomial regression was used to compare the primary outcome of hospital LOS between the proactive (n = 65), concurrent control (n = 63), and reactive historical control (n = 45) groups. Patient satisfaction, hospitalist satisfaction, and recommendation concordance (degree to which psychiatry recommendations were implemented by the primary team) were also compared between groups as secondary outcome measures.
Results:
After adjusting for age, sex, race, insurance type, reason for consult, and medical diagnosis, concurrent control patients had 14% (P = 0.295) longer mean LOS than proactive consults, and historical controls had twice (P < 0.001) the mean LOS of those with proactive consults. Response rate for patient satisfaction scores was low, but responses were modestly more favorable among patients who received proactive consultation-liaison services. Based on nine paired pediatric hospitalist presurveys and postsurveys, follow-up surveys were statistically significantly more favorable after a proactive psychiatry consult service was introduced. Concordance of recommendations was observed to be higher for proactive consults than concurrent controls for diagnoses and nonmedication (other) recommendations.
Conclusions:
The positive impact of a proactive consultation-liaison psychiatry consultation model was observed in a pediatric hospital and was associated with a lower LOS than concurrent controls and historical reactive consults, higher hospitalist satisfaction among paired responses, and greater concordance of diagnosis and other non-medication recommendations.
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