An Audit of Inpatient Consultation-Liaison Psychiatry Services at an Inner New York City Safety Net Hospital

Tarika Nagi; Saurabh Somvanshi; Gautam Shanmuga Dharmar Balasubramania Pandian; Subbulakshmi Mohan; Brian Altonen

doi:10.7759/cureus.34801

An Audit of Inpatient Consultation-Liaison Psychiatry Services at an Inner New York City Safety Net Hospital

Cureus. 2023 Feb 9;15(2):e34801. doi: 10.7759/cureus.34801. eCollection 2023 Feb.

Authors

Tarika Nagi¹, Saurabh Somvanshi², Gautam Shanmuga Dharmar Balasubramania Pandian², Subbulakshmi Mohan¹, Brian Altonen³

Affiliations

¹ Psychiatry, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA.
² Psychiatry and Behavioral Sciences, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA.
³ Data Analysis and Statistics, New York City Health and Hospital Corporation, New York, USA.

Abstract

Background Our study's primary objective is to audit the resource utilization of a consultation-liaison (CL) psychiatry service in an inner New York City safety net hospital. This cross-sectional, observational study was conducted as a subset of a quality improvement project at the hospital to investigate the characteristics of the emergent nature of consults, types, and the specialty from which the referral was placed to the CL services. This study aims to improve the efficacy of our consult process by improving the appropriateness and precision of consult requests. Methodology This cross-sectional, observational study was reviewed and approved by the Institutional Review Board under a quality improvement exemption. The study investigated the EPIC electronic medical record data for characteristics of consult referrals in the third quarter of 2019 from July 1, 2019, to September 30, 2019. A total of 629 consults were recorded during this period. We excluded follow-up calls, duplicate data rows, and patients with missing data points; the final consults were 421. Patients who required more than one new consult (follow-up excluded) within 90 days were considered; thus, the total number of patients who were included in the study was 327. Results Of the 421 consults identified in the dataset for review, only 45.8% were valid consults, 32.8% were not valid, and 21.4% were uncertain. Further, the most common department from which consults were placed was Medicine (73.2%), followed by Surgery (12.8%), Obstetrics/Gynecology (9%), Critical Care (3.6%), and, finally, Pediatrics (1.4%). Conclusions The study overviews the quality of general consults for the CL psychiatry service and how the CL staff manages it. It also provides an idea about the number of consults that can be comprehensively addressed.

Keywords: consultation-liaison psychiatry; hospital-based medicine; inner city safety net hospital; mental health and psychiatry; multidisciplinary teams; physician satisfaction; process & performance improvement; quality improvement research.