Psychological Consultation Services in the Medical Intensive Care Unit: A Retrospective Observational Study.

Area of Science:

• Critical Care Medicine
• Psychology
• Health Services Research

Background:

• Critically ill patients and their families experience significant psychological stress and are at risk for lasting psychiatric issues.
• The role of embedded clinical psychologists in medical intensive care units (MICUs) is understudied.
• Dedicated psychology services can address the unmet psychological needs in critical care.

Purpose of the Study:

• To characterize consultation patterns and service utilization of embedded psychology services in two MICUs.
• To compare service delivery models and patient/family needs across different academic medical centers.
• To inform future research on the impact of psychological interventions in critical care.

Main Methods:

• A retrospective observational study of two embedded clinical psychology service models in MICUs.
• Analysis of psychology consultation data from two large, urban academic medical centers over one year (N=428).
• Descriptive statistics and inferential tests (chi-square, independent t-tests) were used to compare variables across sites.

Main Results:

• Family support was the primary reason for consultation (28-40%).
• Common patient referrals included anxiety, depression, adjustment, and coping difficulties; many patients (approx. one-third) did not receive a formal psychiatric diagnosis.
• Elevated mortality (40-43%) and comfort care transitions (25-26%) were observed in referred patients, with Site 2 showing longer ICU/hospital stays and higher ECMO use.

Conclusions:

• Embedded psychological services are highly utilized in MICUs for patient and family support, especially with communication barriers, end-of-life care, and high medical complexity.
• Clinically significant distress exists even without formal psychiatric diagnoses, supporting the value and need for psychological interventions in critical care.
• Future research should investigate the association between psychology consultations and ICU outcomes, including length of stay, delirium, and post-ICU psychological well-being for patients and families.