超越学术医院设置的主动C-L精神病学:郊区社区医院有效性的试点研究

IF 3.4 Q2 Medicine
Joseph Kugler M.D. , Garrett Key M.D. , Mark Oldham M.D.
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引用次数: 3

摘要

背景主动咨询-联络精神病学提高了对精神需求的识别,减少了学术临床环境中住院患者的精神咨询时间和住院时间(LOS)。目的评价主动就诊模式对某非学术性社区医院LOS、会诊率和会诊延迟的影响。方法在某社区医院32张急症外科病房实施改进型主动会诊联络服务(PCS)。我们将90天PCS干预期间的结果与在同一单位接受常规咨询的干预前和干预后队列进行了比较。在干预期间,一名精神病医生审查了研究单位收治患者的电子病历,以指导建议,并与现有单位工作人员合作。主要结果为LOS、会诊率和会诊延迟。次要结果包括约束使用、1:1陪伴使用和由单位护理人员完成的调查。结果研究单位半数患者有精神疾病合并症。PCS队列的中位生存期为3.0天,而干预前和干预后队列的中位生存期为5.0天。PCS组的咨询率更高(干预前为1.4%;33%的干预;干预期间,中位咨询潜伏期也有所减少(干预前57.6 h;干预19.2 h;干预后48 h)。结论改进后的PCS模式在社区医院实施是可行的,可以降低LOS,提高精神科服务利用率,减少会诊延迟。这项研究表明,积极主动的会诊联络可以为非学术社区医院提供与大型学术中心相同的好处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Proactive C-L Psychiatry Beyond Academic Hospital Settings: A Pilot Study of Effectiveness in a Suburban Community Hospital

Background

Proactive consultation-liaison psychiatry improves identification of psychiatric needs and reduces time to psychiatric consultation and length of stay (LOS) among medical inpatients in academic clinical settings.

Objective

To evaluate the effect of a proactive model on LOS, consult rate, and consultation latency in a nonacademic community hospital.

Methods

We implemented a modified proactive consultation-liaison service (PCS) in a 32-bed acute care medical-surgical unit in a community hospital. We compared outcomes during a 90-day PCS intervention period to preintervention and postintervention cohorts receiving consultation-as-usual in the same unit. During the intervention, a psychiatrist reviewed the electronic medical record of patients admitted to the study unit to guide recommendations and collaborated with existing unit staff. Primary outcomes were LOS, consultation rate, and consultation latency. Secondary outcomes included restraint utilization, 1:1 companion utilization, and a survey completed by unit nursing staff.

Results

Half of patients on the study unit had psychiatric comorbidity. Median LOS in the PCS cohort was 3.0 days versus 5.0 days in the preintervention and postintervention cohorts. The consultation rate was higher in the PCS cohort (1.4% before intervention; 33% intervention; 6.5% after intervention), and median consultation latency was also reduced during the intervention (57.6 h before intervention; 19.2 h intervention; 48 h after intervention).

Conclusions

Implementation of a modified PCS model is feasible in a community hospital setting and can reduce LOS, enhance psychiatric service utilization, and reduce consultation latency. This study demonstrates that proactive consultation-liaison may offer the same benefits to nonacademic community hospitals as it does to large academic centers.

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来源期刊
Psychosomatics
Psychosomatics 医学-精神病学
CiteScore
3.20
自引率
0.00%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The mission of Psychosomatics is to be the leading psychiatry journal focused on the care of patients with comorbid medical and psychiatric illnesses. The scope of Psychosomatics includes original research, review articles and clinical reports that address psychiatric aspects of medical illnesses and their management. Areas of particular interest include: the effect of co-morbid psychiatric conditions on the management of medical illness; the psychiatric management of patients with comorbid medical illness; educational content for physicians and others specializing in consultation-liaison (C-L) psychiatry; and, the provision of psychiatric services to medical populations, including integrated care.
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