Proactive Psychiatry: Innovating the Delivery of Consultation-Liaison Services in a Pediatric Hospital.

ABSTRACT

BACKGROUND: The benefits of a proactive consultation-liaison (C-L) psychiatry service have been well-documented in the adult population, including decreased length of stay, 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 ages 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. METHOD: 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 length of stay 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 length of stay than proactive consults and historical controls had twice (p < 0.001) the mean length of stay of those with proactive consults. Response rate for patient satisfaction scores was low, but responses were modestly more favorable among patients who received proactive C-L services. Based on nine paired pediatric hospitalist pre- and post- surveys, 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 non-medication (other) recommendations. CONCLUSION: The positive impact of a proactive C-L psychiatry consultation model was observed in a pediatric hospital and was associated with a lower length of stay than concurrent controls and historical reactive consults, higher hospitalist satisfaction among paired responses, and greater concordance of diagnosis and other non-medication recommendations.