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).
Method
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.
Results
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.
Conclusions
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.
This work has been presented at the Academy of Psychosomatic Medicine Annual Meeting (November 2013) and the American Psychiatric Association Annual Meeting (May 2014). The work was supported in part by a philanthropic donation from the Barbara and Donald Jonas Foundation that provided salary support for Dr. Skomorowsky.
