Innovative Insights: Unraveling Factors Affecting Cross-Coverage on a Pediatric Consultation-Liaison Service

Abstract:
Background


Pediatric Consultation-Liaison (CL) Services are essential to provide comprehensive and integrated mental health care to children and adolescents who are medically hospitalized. However, increased level of medical acuity and shorter lengths of stay have led to increased work demands, with over 60% of pediatric CL psychiatry programs reporting an increased volume of consult requests, and 42% reporting difficulties recruiting child psychiatry staff and faculty (Shaw 2006). Few studies have evaluated physician satisfaction on CL Psychiatry Services, and there are limited studies evaluating factors affecting CL cross coverage. The current study evaluated factors that could improve attending physician satisfaction and comfort during cross coverage on a pediatric CL service.





Methods:


Twenty-four Child and Adolescent Psychiatrists (CAPs) at a midwestern academic pediatric hospital were anonymously surveyed on call preference, comfort with CL call, and factors that may be associated with comfort and willingness to take call. After survey completion, smart phrases, note templates, clinical algorithms, and billing summaries were created for the 10 most encountered problems on CL services. CAPs were encouraged to use these interventions. A modified survey was collected approximately one-year post-intervention to determine the impact of these interventions on call satisfaction and comfort with covering the pediatric CL service on cross-coverage. Statistical analysis was completed using Mann-Whitney U and chi-square tests.





Results:


The majority of physicians were trained in General Psychiatry (78.6%) and CAP (82.1%). 3.6% reported being trained in Pediatrics, 3.6% certified in Hospice and Palliative Medicine and 17.9% were Triple Boarded (General, CAP and Pediatrics). Two-thirds (67.9%) reported feeling anxious when managing specific types of CL patients. Confusion regarding billing was the primary reason 25% of CAPs did not wish to take CL cross-coverage. Having an APN or fellow on cross-coverage increased comfort and willingness in taking CL cross-coverage by 62.7% and 39.3% respectively.Having access to smart phrases did not improve comfort and willingness to take call post-interventions; however 50% of physicians surveyed were not aware that they had access to clinical algorithms and note templates to help guide and facilitate completion of consults during cross coverage.






Discussion:


Factors that modulated comfort included: lack of familiarity with the hospital in which the CL call takes place, anxiety about specific patient populations commonly treated on CL, having access to note templates and problem specific smart phrases, and working with an APN or fellow. The data did trend towards positive outcomes with interventions of creating a note template and smart phrases for physicians to use for specific CL related psychiatric disorders.








Conclusion:


Faculty satisfaction has been of longstanding interest to institutions because of its association with faculty retention and increased organizational performance. This is one of the first studies evaluating CAP attending physician comfort and willingness to take CL call. More research is needed to evaluate successful interventions to improve cross-coverage on Consultation-Liaison Services.






References:


Shaw, R. J., et al. (2019). "Core competencies for pediatric consultation-liaison psychiatry in child and adolescent psychiatry fellowship training." Psychosomatics 60 (5): 444-448.


Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: The project can advance diversity, equity and inclusion by exploring how implicit bias and stereotypes may influence decisions related to cross-coverage. It can also help with development of policies that promote inclusivity and support equitable distribution of responsibilities among physicians