title: Co-managed Care for Medical Inpatients, C-L vs C/L Psychiatry.
abstract: We report on a quality improvement program to co-manage patients with co-morbid medical and psychiatric disorders in the general hospital. A philanthropic donation allowed a high volume, high-acuity urban hospital to hire a co-managing inpatient psychiatrist. The expectation was that facilitating psychiatric evaluation/treatment of medical patients would result in fewer patients staying beyond the expected length of stay (LOS).
  
  
  
  The psychiatrist became a member of a general medical team working with a group of internists and actively co-managing medical patients. After one year, we compared time-to-consultation request and LOS for patients seen through the traditional Consultation-Liaison model and patients seen through the co-managed care model. A second co-managing psychiatrist was hired. A new QI project investigated reduction in lost days.
  
  
  
  There was a decrease in LOS for patients seen in the co-managed care model when compared with those seen via the traditional Consultation-Liaison model. Co-managed patients were seen earlier in the hospitalization. Excluding very-long-stay outliers, there was a reduction in LOS of 1.19 days (p < 0.003). There was an estimated annualized saving to the hospital of 2889 patient days.
  
  
  
  A program of co-managed care reduced both LOS and lost days to the hospital. This resulted in an increase in hospital support to hire 2.5 full-time equivalent psychiatrists and 1.0 full-time equivalent social worker for the Consultation-Liaison service. Such programs may permit the return of modernized psychiatric liaison programs to medical and surgical services.
authors.affiliation: NY-Presbyterian Hospital/Columbia Campus, Columbia University Medical Center, New York, NY. Electronic address: prm1@cumc.columbia.edu.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Muskin
authors.affiliation: NY-Presbyterian Hospital/Columbia Campus, Columbia University Medical Center, New York, NY.
authors.forename: Anne
authors.initials: A
authors.lastname: Skomorowsky
authors.affiliation: New York State Psychiatric Institute, Columbia University Medical Center/NY-Presbyterian Hospital, New York State Psychiatric Institute, New York, NY.
authors.forename: Ravi N
authors.initials: RN
authors.lastname: Shah
mesh_terms: D015897:Comorbidity; D003299:Cooperative Behavior; D017046:Cost Savings; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D020445:Hospitalists; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration*; D011570:Psychiatry; D058996:Quality Improvement
keywords: collaborative care; cost-offset; length of stay; liaison; philanthropy