(191) Proactive Consultative Psychiatry: An Interdisciplinary Teaching Model

Proactive Consult Liaison (C-L) psychiatry on inpatient medical units is associated with an increased consultation rate, reduced length of stay, fewer clinical complications, decreased time to psychiatric evaluations1, and enhanced primary team satisfaction2. However, little has been studied about how proactive psychiatric consultation can be used as an interdisciplinary teaching model for inpatient medical residents and nurses.

An initial needs assessment consisted of surveys and interviews with 36 medical residents, hospitalists, and nurses at an academic teaching county hospital . Responses demonstrated a clear desire among practitioners for more frequent access to psychiatric consultation and collaborative management of complex psychiatric medical inpatients. Participants also expressed interest in learning about a wide range of psychiatric teaching topics and patient populations, emphasizing a general lack of knowledge in acute psychiatric management and role for further education.

Based on this assessment, we implemented a proactive psychiatric consultation QI project among three out of the five resident-run inpatient medical teams from February 1, 2023 through May 31, 2023. A C-L psychiatry attending rounded with each team four afternoons per week, Monday through Friday, to review all admissions. Psychiatric consultations, assessments and plans were collaboratively created with patients’ primary physician and nursing teams. Through partnership with medical chief residents, we also developed structured educational opportunities through morning reports and morbidity and mortality conferences with psychiatric foci.

Surveys were administered at the beginning and end of medical providers’ month-long rotations; physicians and nurses received surveys tailored to their respective careers. The pre- and post- intervention surveys contain identical Likert scales that assess a variety of learning objectives, including: suicidal ideation, delirium, substance use, decisional capacity, and psychiatric pharmacology. It also assessed psychiatric discharge planning, coordination with other behavioral health services, burn-out symptoms, and perceptions of providing equitable care. Participants were compensated with electronic gift cards for each completed survey.

Data collection has begun, and findings will be available for presentation at this meeting. Survey data will be analyzed using paired t-tests to determine mean change in Likert scale rating from baseline to post-intervention for each of eleven principal topics. Results will be further analyzed based on health care profession and years of experience. Open comment fields on the surveys regarding qualitative feedback will also be collected, analyzed and presented.

We hypothesize an overall benefit of this interactive, case-based, interdisciplinary approach. Significant changes in scores will allow us to identify educational topics most affected by our intervention. Topics with high scores and little change may need less emphasis for additional educational efforts. Topics with low scores and little change will be prioritized for further program development.

1. Desan PH, Zimbrean PC, Weinstein AJ, Bozzo JE, Sledge WH. Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team. Psychosomatics. 2011 Nov-Dec;52(6):513-20.

2. Oldham MA, Walsh P, Maeng DD, et al. Integration of a proactive, multidisciplinary mental health team on hospital medicine improves provider and nursing satisfaction. J Psychosom Res. 2020 Jul;134:110112.