Effect of timing of psychiatry consultation on length of pediatric hospitalization and hospital charges.
OBJECTIVE
The purpose of this study was to evaluate the impact of timing of a psychiatry consultation during pediatric hospitalization on length of hospital stay and total hospitalization charges.


METHODS
The charts of 279 pediatric patients (totaling 308 consultations) referred to the psychiatry consultation liaison service at a freestanding tertiary pediatric hospital between January 1, 2010, and June 30, 2010 were retrospectively analyzed. The variables analyzed included the following: patient demographic characteristics; dates of admission, psychiatric consultation, and discharge; psychiatric diagnoses based on the psychiatric diagnostic evaluation; psychiatric treatment disposition; and illness severity and total charges associated with the medical stay.


RESULTS
Earlier psychiatry consultation was associated with shorter length of stay and lower hospitalization charges after adjusting for psychiatric functioning, physical illness severity, and psychiatric disposition. Poorer psychiatric functioning and milder physical illness were associated with shorter referral time.


CONCLUSIONS
Timely involvement of psychiatry consultation services during a medical or surgical hospitalization was associated with reductions in length of stay and total hospital charges in pediatric settings. These findings have important effects on quality of care via decreasing burden on the patient and family and on the medical system resources. Educating pediatric health care providers about the importance of early psychiatry consultation regardless of physical illness severity or psychiatric acuity will likely improve resource management for patients and hospitals.
Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and simona.bujoreanu@childrens.harvard.edu.
Simona
S
Bujoreanu
Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and.
Matthew T
MT
White
Department of Psychology, Austin State Hospital, Austin, Texas.
Bradley
B
Gerber
Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and.
Patricia
P
Ibeziako
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017722:Hospital Charges; D006776:Hospitals, Pediatric; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D001523:Mental Disorders / Q000628:therapy*; D011570:Psychiatry; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
child and adolescent; hospital charges; length of stay; liaison psychiatry; medical hospitalization; psychiatry consultation service