Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
BMC Psychiatry. 2022 Mar 18;22(1):198. doi: 10.1186/s12888-022-03855-w.
Many critical illness survivors experience new or worsening mental health impairments. Psychiatry consultation services can provide a critical role in identifying, addressing, and preventing mental health challenges during and after admission to the acute medical care setting. However, psychiatry involvement in the ICU setting is lower than in other hospital settings and the conventional process in many hospitals requires other care providers to request consultation by psychiatry. Despite these differences, no studies have sought ICU provider perspectives on psychiatry consultation's current and desired role. We aimed to obtain stakeholder feedback on psychiatry's current and desired roles in the ICU, and potential benefits and drawbacks of increasing psychiatry's presence.
A web-based survey obtained perspectives from 373 critical care physicians and advance practice providers, bedside nurses, physical and occupational therapists, pharmacists, and consultation-liaison psychiatry physicians and advance practice providers at a tertiary care center using multiple choice and open-ended questions. Descriptive information and content analysis of qualitative data provided information on stakeholder perspectives.
Psychiatry's primary current role was seen as assistance with management of mental health issues (38%) and suicide risk assessments (23%). 46% wished for psychiatry's increased involvement in the ICU. Perceived benefits of increased psychiatry presence in the ICU included early psychological support in parallel with medical care, identification of psychiatric factors impacting treatment, and facilitation of family understanding of the patient's mental state/delirium. An additional perceived benefit included reduction in provider burnout through processing difficult situations and decreasing family psychological distress. However, one concern included potential conflict among providers regarding treatment.
Those who work closely with the critically ill patients think that increased psychological support in the ICU would be beneficial. By contrast, psychiatry's current involvement is seen to be limited, perhaps driven by varying perceptions of what psychiatry's role is or should be.
许多重症疾病幸存者经历新的或恶化的心理健康损伤。精神病学咨询服务可以在识别、解决和预防急性医疗保健环境中的入院期间和之后的心理健康挑战方面发挥关键作用。然而，精神病学在 ICU 环境中的参与度低于其他医院环境，并且许多医院的常规流程要求其他护理提供者请求精神病学咨询。尽管存在这些差异，但尚无研究探讨 ICU 提供者对精神病学咨询当前和期望角色的看法。我们旨在获得利益相关者对精神病学在 ICU 中的当前和期望角色的反馈，以及增加精神病学参与度的潜在益处和缺点。
一项基于网络的调查从一家三级护理中心的 373 名重症监护医师和高级实践提供者、床边护士、物理治疗师和职业治疗师、药剂师以及联络精神病学医师和高级实践提供者那里获得了观点，采用多项选择和开放式问题。描述性信息和定性数据的内容分析提供了利益相关者观点的信息。
精神病学的主要当前角色被视为协助管理心理健康问题（38%）和自杀风险评估（23%）。46%的人希望增加精神病学在 ICU 的参与度。增加精神病学在 ICU 中的存在的潜在益处包括与医疗护理同时提供早期心理支持、识别影响治疗的精神因素以及促进家属了解患者的心理状态/意识障碍。另一个被认为的益处包括通过处理困难情况和减少家属心理困扰来减少提供者倦怠。然而，一个关注的问题是，提供者之间可能存在治疗方面的潜在冲突。
与重症患者密切合作的人认为 ICU 中增加心理支持将是有益的。相比之下，精神病学的当前参与度被认为是有限的，这可能是由于对精神病学角色的看法或应该是什么存在差异。
