Critical Care Psychiatry: Can the Proactive Approach Work in the ICU?

Jointly sponsored by the Critical Care and Proactive C-L Psychiatry SIGs, this interactive workshop will explore the application of proactive C-L principles to critical care settings. Critical care psychiatry is the natural next frontier for proactive C-L,1 giving the field an actionable playbook of principles and practices for implementing collaborative, cost-effective, and equitable psychiatric care in the ICU setting.2

The literature on integrated C-L services to date has largely focused on general medicine settings, yet one expects even greater value in applying these principles to settings with higher healthcare costs and where preexisting and emergent psychiatric morbidity is greater.2 Critical care spending accounts for nearly 1% of the U.S. gross domestic product (GDP), and mental health morbidity in critical care is extremely high, with an estimated 40% of patients having pre-existing cognitive impairment and up to 80% developing delirium.

Dr. Oldham (15min) will explore how the principles of proactive C-L psychiatry, such as systematic screening and an interdisciplinary team-based approach, apply to a critical care environment and the unique value they offer, including how they can facilitate equitable access to psychiatric services.

Dr. Dragonetti (15min) will describe the integration of C-L psychiatry and critical care services and explore its value in terms of patient experience, health outcomes, staff impact, and business-related metrics. Current knowledge will be synthesized and extrapolated based on what is known from other integrated models so that participants better understand how to apply core principles in their own practice settings.

The first interactive discussion (15min) will prompt attendees to share their experiences of ICU culture and intensivist receptivity to psychiatric services. Collective input will be used to explore common challenges with service integration among institutions of different sizes, encouraging attendees to collaboratively troubleshoot and brainstorm solutions.

Dr. Maldonado (15min) will present his experience developing and implementing an integrated–proactive Critical Care Psychiatry Service in the Cardiovascular ICU in a tertiary academic institution. He will review how proactive principles were implemented, including screening methods (e.g., choosing the best tools for the selected outcome), workflow optimization, team composition (e.g., co-rounding, automated reports), and mutual cross-discipline education (e.g., co-learning alongside respiratory, physical, and occupational therapists, and ICU social workers).

Dr. Bui (15min) will propose pragmatic steps to increase C-L psychiatry integration into critical care. She will review different models ranging from an increased liaison presence to building a standalone critical care psychiatry service. Core concepts will include conducting needs assessments, evaluating available resources, cultivating stakeholder buy-in, measuring effectiveness, and iterative redesign.

The second interactive discussion (15min) will focus on systemic barriers to change and soliciting attendees’ experiences of partnering with critical care colleagues to implement change at the service line level. Discussion will permit attendees to reflect upon their own collaborations, facilitating larger discussions and possibly even inter-institution partnerships.

1Bui doi.org/10.1016/j.psym.2018.07.011

2Oldham doi.org/10.1016/j.jaclp.2021.01.005