Background: Little has been published about transition of care for patients with catatonia. Generally, for patients with psychiatric illness transitions of care are high-risk time periods with increased risk of suicide attempt (1). Interventions to decrease risk during care transition include collaboration between care teams, identification of barriers early in hospitalization, and troubleshooting these to increase likelihood of continued access in the outpatient setting (2). Catatonia can be caused by severe medical conditions (e.g., autoimmune encephalitis) and patients with catatonia may experience comorbidities requiring medical admission with psychiatric care provided through consultation. In addition to its occurrence in medical conditions, catatonia also occurs in more severe psychiatric illness and risk of suicide in patients with catatonia is 500-fold higher than in the general population (3). Thus, transitions of care are more challenging, with medical teams often working outside their scope to facilitate safe discharge planning in this vulnerable population.
Methods: As a busy inpatient consultation service serving the pediatric hospital of a larger adult hospital system, difficulty in care transition for our most ill and complex patients had been a longstanding challenge. Implementation of a weekly case conference with our neighboring institution to include several key stakeholders has been piloted as a way to facilitate transition of care. Attendees at this case conference include inpatient consultation liaison psychiatry, outpatient neuropsychiatry and developmental disabilities psychiatry, neuropsychology, behavioral psychology, physical medication and rehabilitation, pediatric neurology, social work, occupational and physical therapy, and trainees.
Results: With implementation of this weekly multi-disciplinary conference, we have experienced enhanced cross-institutional patient care. We present a case of catatonia in an adolescent where this intervention facilitated crucial communication across care settings resulting in optimization of transition and improved patient care. In addition to discussion of step-down criteria, reasons for step-up to inpatient care are discussed. This increased collaboration and trust has led to identification of outpatient care for patients who historically have struggled to access necessary services.
Discussion: This regular interdisciplinary case-discussion provides a consistent communication strategy for stakeholders caring for patients with medical and neuropsychiatric complexity across care settings. This forum serves as a way for clinicians to develop relationships and to proactively identify challenges and troubleshoot as a cohesive team. This collaboration allows for improved transitions of care for patients and decreases barriers to communication.
Conclusion: Use of interdisciplinary city- or region-wide case-conference as a way to identify appropriate outpatient care is a novel approach to discharge planning that has led to successful care transitions for several complex patients.
References: 1. Fawcett, J., Scheftner, W., Clark, D., Hedeker, D., Gibbons, R., & Coryell, W. (1987). Clinical predictors of suicide in patients with major affective disorders: A controlled prospective study. American Journal of Psychiatry, 144(1):35-40. 2. Care Transitions Work Group, National Action Alliance for Suicide Prevention. (2019). Best Practices in Care Transitions for Individuals with Suicide Risk: Inpatient Care to Outpatient Care. SAMSHA.gov/sites/default/files/suicide-risk-practices-in-care-transitions-11192019.pdf 3. Hauptman AJ, Benjamin S. The Differential Diagnosis and Treatment of Catatonia in Children and Adolescents. (2016). Harvard Review of Psychiatry. 24(6):379-395.
