[Multinational European project and multicenter Spanish study of quality improvement of assistance on consultation-liaison psychiatry in general hospital: clinical profile in Spain].
BACKGROUND
In the frame of the European study on quality assurance in consultation liaison psychiatry and psychosomatics (supported by the BIOMED 1 program), the clinical <<process>> of consultation-liaison psychiatry units pertaining to six Spanish general hospitals is analyzed.


METHODS
A sample of 3. 608 consecutive patients referred to the consultation-liaison psychiatry units of five public general hospitals (Clínico of Zaragoza, Clínico of Barcelona, General of Alicante, Ramón y Cajal of Madrid, Princesa of Madrid) and one private gynecological hospital (Dexeus of Barcelona) was studied. The data were recorded with a standardized instrument (CL-BDoK-P), validated in a previous study.


RESULTS
Consult request took place 10.6 days (on average) after the patients admission (<<lagtime 1>>), half the requests were urgent, and psychiatric consultants examined the patients 1.9 days (on average) after the request (<<lagtime 2>>). The most frequent reasons for referral were current psychiatric symptoms (50.3%), unexplained physical symptoms (15.2%), substance abuse (9.2%), psychiatric history (8.5%), suicide risk (6%) and coping with illness (5.8%). The main referral services were internal medicine (17.5%), traumatology (7.5%) and general surgery (7.3%). An important clinical activity is documented in patients frequently considered to be <<complex>>, with broad spectrum diagnostic and interventions processes and both in-hospital and out-patient follow-up. However, some problems were also detected in the clinical <<process>>.


CONCLUSIONS
The results outline the clinical importance of Spanish consultation-liaison psychiatry in the general hospital, but the possibility of improving its efficiency through the implementation of integrative models, organizational changes and modern models of <<quality assurance>> is also emphasized.
Valdés
M
M
Servicio de Psicosomática y Psiquiatría de Enlace. Hospital Clínico Universitario de Zaragoza. mvaldes@clinic.ub.es
de Pablo
J
J
Campos
R
R
Farré
J M
JM
Girón
M
M
Lozano
M
M
Aibar
C
C
García-Camba
E
E
Martínez Calvo
A
A
Carreras
S
S
Stein
B
B
Huyse
F
F
Herzog
T
T
Lobo
A
A
D000328:Adult; D000553:Ambulatory Care / Q000592:standards; D005060:Europe; D005260:Female; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D011567:Psychiatric Department, Hospital; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D013030:Spain