title: Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team.
abstract: BACKGROUND
  Some studies suggest intensive psychiatric consultation services facilitate medical care and reduce length of stay (LOS) in general hospitals.
  
  
  OBJECTIVE
  To compare LOS between a consultation-as-usual model and a proactive consultation model involving review of all admissions, rapid consultation, and close follow-up.
  
  
  METHODS
  LOS was compared in an ABA design between a 33-day intervention period and 10 similar control periods, 5 before and 5 after the intervention, on an internal medical unit. During the intervention period, a staff psychiatrist met with the medical team each weekday, reviewed all admissions, provided immediate consultation as needed, and followed all cases throughout their hospital stay.
  
  
  RESULTS
  Time required for initial case review was brief, 2.9 ± 2.2 minutes per patient (mean ± S.D.). Over 50% of admissions had mental health needs: 20.3% were estimated to require specialist consultation to avoid potential delay of discharge. The consultation rate for the intervention sample was 22.6%, significantly greater than in the control sample, 10.7%. Mean LOS was significantly shorter in the intervention sample, 2.90 ± 2.12 versus 3.82 ± 3.30 days, and the fraction of cases with LOS > 4 days was significantly lower, 14.5% versus 27.9%. A rough cost benefit analysis was favorable with at least a 4.2 ratio of financial benefit to cost.
  
  
  CONCLUSIONS
  Psychiatric review of all admissions is feasible, indicates a high incidence of mental health barriers to discharge, identifies more necessary consultations than typically requested, and results in earlier consultation. A proactive consultation model can reduce hospital LOS.
authors: Department of Psychiatry, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT 06504, USA. paul.desan@yale.edu
authors: Paul H
authors: PH
authors: Desan
authors: Paula C
authors: PC
authors: Zimbrean
authors: Andrea J
authors: AJ
authors: Weinstein
authors: Janis E
authors: JE
authors: Bozzo
authors: William H
authors: WH
authors: Sledge
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007400:Interprofessional Relations; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D020380:Needs Assessment / Q000191:economics; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D010343:Patient Admission; D010348:Patient Care Team; D011570:Psychiatry / Q000458:organization & administration*; D013811:Psychotherapeutic Processes; D012017:Referral and Consultation; D013997:Time Factors