Medical patients with comorbid psychiatric illness comprise 20-40% of general medicine inpatient admissions. These patients often have multiple providers involved in their care which can lead to poor communication, longer lengths of stay, and increased resource utilization. Despite substantial need, no standard model of care exists for this patient population. At our academic medical center, patients with comorbid psychiatry and medical diagnoses were historically treated on a specialty unit without coordinated physician, nursing, or case management interaction. Between Sept 2015 and January 2016, the unit experienced 66 incidents of patient-staff violence and had an emergency room utilization rate of 15% and 29% at 7 and 30 days.
Our goal was to create a comprehensive co-management model that would improve care of the complex medical and psychiatric needs of our indigent patient population
In January 2016, the academic hospitalist service created a novel multidisciplinary approach to care for medically and psychiatrically complex patients. Patients were selected by nursing unit leadership according to their behavioral traits and risk of hospital elopement. Qualifying patients were cohorted on a 10-bed ‘Medicine Secure’ unit located adjacent to the inpatient psychiatry unit and staffed by medicine nurses with specialized psychiatric training. Medical decision-making was led by a geographically based hospitalist attending. Each morning, a multidisciplinary care team including the attending hospitalist, consulting psychiatrist, social workers and case managers from both medicine and psychiatry services, nursing leadership from both the ‘Medicine Secure’ unit and inpatient psychiatry discussed aspects of inpatient care and comprehensive discharge planning for all unit patients. Both the hospitalist attending and inpatient psychiatry team shared responsibility for co-management, medical and psychiatric emergency response, and discharge planning including medicine reconciliation.
Through systematic cooperation utilizing internal medicine and psychiatry resources, superior safety and quality outcomes were achieved without additional cost. Total reported adverse safety events were reduced by 52% (p<0.01) with a corresponding 51% reduction in patient violence (p<0.01) and a 52% reduction in falls (p=0.05). Coordination of care and discharge planning also improved, as noted by a 63% decrease in visits to the Emergency Department within 30 days of discharge (p=0.01). Lengths of stay were unchanged (p=0.35). In our academic medical center, medicine-psychiatry collaboration has proven a successful means of caring for a complex and vulnerable patient population.
To cite this abstract:Mathis, HM; Odedosu, K; Harder, S . CAN WE DO BETTER? IMPLEMENTATION OF A HOSPITALIST-PSYCHIATRY COLLABORATIVE FOR THE IMPROVEMENT OF CARE FOR BEHAVIORALLY AND MEDICALLY COMPLEX PATIENTS. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 190. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/can-we-do-better-implementation-of-a-hospitalist-psychiatry-collaborative-for-the-improvement-of-care-for-behaviorally-and-medically-complex-patients/. Accessed February 25, 2020.