Use of a Structured Framework with Novel Outcome Measures to Describe a Consultation-Liaison Psychiatry Service and its Effectiveness

摘要

This article describes a new consultation-liaison psychiatry (CLP) service at a subacute hospital in Melbourne, Australia, using a structured framework and novel outcome measures. It also describes the psychiatric needs of the rehabilitation and geriatric evaluation and management (GEM) units. The "structure-process-outcomes" framework was used to anchor objective measures of CLP effectiveness. Relevant information was collected on all admissions and CLP referrals between February and July 2019. Planned and post hoc statistical tests were performed to determine significant associations. Results showed that 22.3% of patients in the rehabilitation unit and 44.2% in GEM unit had active psychiatric disorders (APD); this cohort had significantly greater length of stay (LOS) and less funding per day of admission. Geriatricians refer a significantly lower proportion of those with APD than rehabilitation physicians, likely due to shared clinical expertise in managing neurocognitive disorders. Those referred have significantly greater psychiatric comorbidity and LOS than those not referred. Despite this, CLP interventions was associated with a significantly reduced number of readmissions in the 180 days postinitial discharge. Describing a CLP service using a structured framework with objective outcome measures allows for deeper and more nuanced evaluation of service effectiveness. A substantial proportion of patients at rehabilitation and GEM units have APD.