Department of Psychiatry, Dayton Children's Hospital, Dayton, OH; Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Fairborn, OH.
Department of Psychiatry, Dayton Children's Hospital, Dayton, OH; Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Fairborn, OH.
J Acad Consult Liaison Psychiatry. 2024 Sep-Oct;65(5):431-440. doi: 10.1016/j.jaclp.2024.07.005. Epub 2024 Jul 29.
The benefits of a proactive consultation-liaison psychiatry service have been well documented in the adult population, including decreased length of stay (LOS), increased satisfaction among physicians, and enhanced collaborative care. However, there is no available research on the effectiveness of this model in pediatric hospitals.
This study compared patients aged 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.
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 LOS 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.
After adjusting for age, sex, race, insurance type, reason for consult, and medical diagnosis, concurrent control patients had 14% (P = 0.295) longer mean LOS than proactive consults, and historical controls had twice (P < 0.001) the mean LOS of those with proactive consults. Response rate for patient satisfaction scores was low, but responses were modestly more favorable among patients who received proactive consultation-liaison services. Based on nine paired pediatric hospitalist presurveys and postsurveys, 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 nonmedication (other) recommendations.
The positive impact of a proactive consultation-liaison psychiatry consultation model was observed in a pediatric hospital and was associated with a lower LOS than concurrent controls and historical reactive consults, higher hospitalist satisfaction among paired responses, and greater concordance of diagnosis and other non-medication recommendations.
主动式联络会诊精神病学服务在成人人群中的益处已得到充分证实，包括缩短住院时间（LOS）、提高医生满意度和增强协作护理。然而，目前尚无关于该模式在儿科医院有效性的研究。
本研究比较了在普通医疗楼层接受主动精神病学咨询的 5-18 岁患者与同期未接受咨询的对照组患者以及历史上接受传统反应性咨询的对照组患者。
在每周工作日的早上，对两名儿科普通医疗团队的新入院患者进行审查，以确定那些有主动精神科问题的患者。使用调整后的负二项式回归比较主动式（n=65）、同期对照组（n=63）和历史反应性对照组（n=45）的主要结果（医院 LOS）。还将组间患者满意度、医院医生满意度和建议一致性（精神病学建议由主要团队实施的程度）作为次要结果进行比较。
在校正年龄、性别、种族、保险类型、咨询原因和医疗诊断后，同期对照组患者的平均 LOS 比主动咨询组长 14%（P=0.295），而历史对照组患者的平均 LOS 是主动咨询组的两倍（P<0.001）。患者满意度评分的回复率较低，但接受主动联络会诊服务的患者的回复则略为有利。根据 9 份配对儿科医院医生预调查和后调查，在引入主动精神病学咨询服务后，后续调查明显更为有利。与同期对照组相比，主动咨询组的诊断和非药物（其他）建议的建议一致性更高。
在儿科医院中观察到主动式联络会诊精神病学咨询模式的积极影响，与同期对照组和历史反应性咨询相比，该模式与较低的 LOS 相关，配对反应中医院医生满意度较高，并且诊断和其他非药物建议的一致性更高。
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