1. 5th Annual Scientific Conference of the European Association of Psychosomatic Medicine –EAPM 2017
Consultation-Liaison Psychiatry: An observational study in a Galician Teaching Hospital (CHUO)
Balseiro E (1), Santiago M.T. (2), Carcavilla C (1), Ortiz R (1), Gómez-Reino I, (3) Simón D (3).
Psychiatric Service. Complexo Hospitalario Universitario de Ourense.
Psychiatryst Training. (2) Physician. (3) Psychiatryst.
Conflict of interest
Authors declare they doesn't have any conflict of interests.
Aims
- Describe the activity of the UPIE in our Hospital (CHUO) during one year by means of recording data elaborated in the service.
- Investigate association between various clinical and quality factors of consultations request in different hospital wards.
- To improve service delivery based on the deficiencies in current practice to better quality management in usual work.
Method
A retrospective observational study is carried out in which dates from all psychiatric consultations patients admitted to the Ourense Universitary Hospital, between January 1st - December 31st, After consultation, some clinical, quality and sociodemographic data are collected and kept in a computerized registry. Chi-Cuadrado of Person were statistically used.
Results
576 consultations were performed, which represents a 2.35% of the patients admitted in 2014 in the CHUO (excluding psychiatry and pediatrics). 40,1% of patients were older than 74. The most requesting services were Internal medicine (35,2%), General surgery (15,5%) and Neurology (6,8%). There are seven services that exceed 3% of requests: anestesiology (5,3%), nephrology (5,2%), neurosurgery (4,9%), neurology (4%), general surgery (3,37%), oncology (3,33%) and internal medicine (3,35%). The main reasons for referrals were agitation and aggressiveness (Graphic 2). Regarding the diagnosis, comparing our hospital with the hospital of Melbourne (21%) and with the participating Spanish hospitals in the ECLW (18,1%), we verified than, in Ourense, the most frequent diagnosis is OMD (Delirium/Dementia) (29,2%). Psychiatric background in our hospital is around 20%, higher than other Spanish (8,5%) or Italian hospitals (3.1%). 50.5% of the consultations requested had a normal priority (Graphic 1), compared to other European hospitals that are around 75%. 15.8% of patients didn't receive psychopharmacological treatment by the psychiatrist (Graphic 3). Support psychotherapy specifically applied only to 1.6%. A small percentage of patients were referred to the acute unit (4.2%) (Graphic 5), although in European studies this figure is much lower. On the other hand, 1.6% were referred to the psychosomatic and liaison consultations, however, in other studies a higher percentage is seen. As recommended by several international guides, one of the goals to be achieved is to see 90% of the requested consultations the same day or the day after.
Conclusions
1. We need to increase the knowledge of hospital agitation guidelines, in surgical wards to decrease the number of referrals due to agitation and Delirium.
2. We need developing Guidelines to treat severe mental disorders in general Hospital wards to improve service delivery.
3. We need increase the percentage of routine referrals (In 24 hours) versus preferential (in the same day) by increasing the knowledge of initial treatment of psychiatric disorders by other services.
4. To develop local Guidelines to psychotherapeutic interventions, which are lower than other hospitals.
5. To introduce Guidelines to transfer patients from the medical-surgical wards to the acute hospitalization unit who are greater than other hospitals.
6. Increase referrals to specific Psychosomatic consultations, developing new outpatients consultations.
7. Achieve 90% of all referrals consultations to be seen by the end of the next working day, developing timeliness guidelines.
8. To introduce new parameters in the data collection to better clinical audit.
Graphic 5.
Graphic 3. Prescribed treatment
Graphic 1. Type of requesting
Normal
Preferential
9,41 days
6,64 days
Average time admission-requesting IC
Middle Age
% Men
% Women
64,6 years
49,1%
50,9%
Sociodemographic characteristics
Total IC
Normal
Urgent
Referential
1,02 days
1,18 days
0 days
1,01 days
Average time requesting-attention IC
Graphic 2. Reasons for consultation
Graphic 4. Diagnosis of the IC