Parameters of consultee satisfaction with inpatient academic psychiatric consultation services: a multicenter study.

BACKGROUND: Consultation-liaison psychiatrists commonly perceive consultee satisfaction as a useful global measure of consultation-liaison service performance. No tool exists to measure consultee satisfaction. A single-site study at Columbia University Medical Center elicited ratings of parameters importantly contributing to consultee satisfaction within consultation-liaison services. OBJECTIVE: The purpose of this study was to assess the generalizability of the rating of importance of these parameters in a larger, multicenter sample. METHODS: From October 2013 to January 2014, a confidential and voluntary Web-based survey was distributed to 133 physicians at 7 academic centers in the United States asking them to rate the importance of 16 performance parameters (identified in the previous single-site study) in determining consultee satisfaction. RESULTS: Overall, 87 recipients (65%) responded to the survey. Among all the 16 items, there was no significant difference between sites in ratings of item importance. Of the 16 parameters, 9 received a mean rating in the "important" to "very important" range. Three items, "completion of consultation within 24 hours of request," "understanding the core questions being asked," and "practical and helpful management suggestions for medical staff" were rated as the most important. Quickly managing behavioral problems, management suggestions for nursing staff, verbal communication of recommendations, providing diagnostic clarification, facilitating transfer to inpatient psychiatry, and providing follow-up consultation were other parameters that were highly valued by consultees. CONCLUSIONS: We found good generalizability across academic medical centers for ratings of parameters important for consultee satisfaction with consultation-liaison services, which can provide the basis for a consultee satisfaction measurement tool.

How do you know your consult service is doing a good job? Generating performance measures for C-L service effectiveness.

BACKGROUND: There is no consensus in the literature on measures for evaluating the performance of general hospital Consultation-Liaison psychiatry services. OBJECTIVE: The purpose of this study was to investigate what indicators might be used to this end. METHODS: We surveyed United States Psychosomatic Medicine fellowship directors (n = 53) about the use of performance measures for their psychiatric consultation services. Results of this survey led to the construction of a second survey, which was distributed to the representatives of services calling for psychiatric consultations at our hospital (n = 21); this survey sought to determine the importance of various performance parameters to overall consultee satisfaction. RESULTS: Sixty-three percent of responding psychiatric consult services do not use any of the parameters identified in the literature as performance measures. Consultee satisfaction was endorsed as a valuable performance indicator by 67.7% of them, but no satisfaction rating instrument was identified. The internal survey of consultees identified 11 of 16 candidate parameters as important or very important to consultee satisfaction, of which "consultant understands the core situation and the core question being asked" received the highest rating. CONCLUSIONS: Consultee satisfaction is perceived as a useful global measure of the effectiveness of a psychiatric consult service. We elicited parameters that can be used to create a measurement tool for consultee satisfaction with Consultation-Liaison services. The use of such a tool merits testing in a larger multicenter study.

The effects of combined perirhinal and postrhinal damage on complex discrimination tasks.

Rats with combined lesions of the perirhinal (PER) and postrhinal (POR) cortices were trained on a complex discrimination in the simultaneous feature-positive and feature-negative discrimination task. In this task, a panel light (L) paired with an auditory stimulus determined whether a tone (T) or white noise (N) would be rewarded (+) or not rewarded (-). Thus, the light feature determined whether the target auditory stimuli were rewarded or not. In each session, trial types were LT+, T-, N+, and LN-. We had hypothesized that damage to the target regions would impair performance on this task. Acquisition was altered in the lesioned rats, but not in the predicted direction. Instead, lesioned rats exhibited significantly enhanced acquisition of the discrimination. Manipulation of intertrial intervals indicated that reduction of proactive interference did not explain the enhancement. Lesioned rats were not different from controls on a multiple-cued interval timing task, providing evidence that the enhancement does not extend to all types of discriminations and is not due to a deficit in timing. Other research shows that rats with PER lesions are impaired on similar tasks, thus the enhancement is likely due to the effects of POR damage. Normally in this task, context is thought to accrue inhibitory control over other cues. Without this inhibitory control, animals might be expected to learn the task more efficiently. Our conclusion is that deficits in processing contextual information underlie the enhanced acquisition observed in rats with combined PER and POR damage on this complex discrimination task.

Is that an unconscious fantasy or an automatic thought? Challenges of learning multiple psychotherapies simultaneously.

Today, psychiatry residents learn multiple psychotherapeutic techniques during their training. Learning these different modalities at the same time can cause confusion in the areas of assessment, making a psychotherapeutic recommendation, and conducting a treatment. To investigate these issues, we presented a complex training case to three psychotherapy experts. Although they had somewhat different ideas about how to treat the patient, there was general consensus that adhering to a single conceptual formulation is key to treating individual patients in psychotherapy. A final discussion addresses the pedagogical implications of this perspective.