Psychiatry consult timing and length of stay (LOS) index: quality improvement project in hospitalized cancer patients.

Abstract: Objective

Hospitalized patients with psychiatric needs utilize greater healthcare resources[1, 2]. Impact on length of stay (LOS) has been recently reviewed in the general hospital setting and studies have found early psychiatric interventions tend to reduce LOS [3-5]. Our hospital utilizes the LOS index, which is the ratio of observed to expected LOS. This metric helps eliminate methodological concerns/adjust for medical comorbidities. Our primary aim is to explore timing of psychiatry consults and LOS index along with other process measures. Our secondary aim is to reduce LOS index by 10% in the next 6 months.

Methods

To explore the timing of the psychiatry consult in relation to the admission, we will collaborate with one team i.e., General Hospital Medicine (HM) which admits patients with various cancer diagnoses. 6-month preliminary data for psychiatry consults across HM units reveals psychiatry consults are placed 6.5 days after admission with an average LOS index 2.03. Thus, admitting provider will assess the need for psychiatry consult within or at 48 hours of admission based on the following criteria: 1. patient has severe degree of depression, anxiety or agitation, or 2. patient is taking >4 psychiatric medications for psychiatric reasons or presence of sentinel psychotropics like lithium, clozapine on admission, or 3. concern for alcohol withdrawal. This will qualify as an “early” psychiatry consult. Patients not admitted to HM will be excluded. Outcome measures including referral criteria used and LOS index for “early” vs routine consults will be assessed. Process measures including number of psychiatry referrals at the start and at the end of the study will be noted. Finally, balancing measures like provider (HM and Psychiatry) satisfaction survey will be considered. We plan to use statistical methods and control charts to monitor above trends.

Results

Preliminary data from 96 psychiatry consults across HM units show an average LOS index of 2.03. Average time from admission to psychiatry consult order is 6.5 days and only 36% of the psychiatry consults requested are within or at 48 hours of admission.

Conclusions

Our project has the potential to inform appropriate use of resources for hospitalized cancer patients.