Psychiatric liaison team may improve early intervention, reduce delirium-associated events

Implementation of a liaison team within a psychiatric department appeared associated with an increased ability for early intervention and a reduction in delirium-associated incidents, according to study results published in Psychiatric Annals.

“Patients admitted to medical wards frequently have mental illness,” Kousuke Hino, MD, assistant professor of the department of psychiatry at Yokohama City University Medical Center and Yokohama City University School of Medicine in Japan, and colleagues wrote. “Identifying such patients and providing appropriate psychiatric consultations can affect patient outcomes and reduce associated medical costs, and the timing of psychiatric consultation can affect the duration of hospital stay, particularly in patients with impaired cognition, delirium, dementia, anxiety and depression. Physical illness may prevent recognition of mental illness, which results in poorer outcomes.”

Although patients with severe psychiatric symptoms are easily diagnosed and receive timely consultations, more subtle psychiatric symptoms may not be detected for a longer time. Patients who undergo physically invasive procedures, or who are admitted at intensive care units, in acute care hospitals are at high risk for delirium, which increases risk for incidents including accidental falls, as well as decreases cognitive functions and increases mortality and health care costs. Various medical fields have implemented team-based medicine with multidisciplinary collaboration to address these issues, according to Hino and colleagues.

In the current study, the investigators sought to determine whether implementation of a psychiatric liaison team was effective for early intervention and improving outcomes among patients with psychiatric risk factors. They retrospectively compared the medical records of 1,263 inpatients at a single hospital who received psychiatric consultation before and after implementation of the liaison team.

Results before and after implementation showed consultation request increases linked to increased referrals at the cardiovascular center (19.8% vs. 33.3%), patients with delirium (44.5% vs. 51.8%) and frequency of nurses’ referrals (0% vs. 26.7%); however, the researchers reported significant decreases in waiting time before consultation request (11 days vs. 9 days), hospital stay duration (36 days vs. 30 days) and incidents (number of falls and inadvertent tube removal) among patients with delirium before treatment (35.8% vs. 26%). Further, they observed a significant increase in physical restraint use (36.6% vs. 44.7%).

“The psychiatric liaison team achieved efficacy of performance in providing early intervention for patients who have risk factors and improving their outcomes,” Hino and colleagues wrote. “The number of new requests was increased after implementation of the psychiatric department liaison team. The ward nurses at specific clinical departments showed improvement in identification of delirium and mediation of requests for psychiatric medical assistance. Thus, the psychiatric liaison team effectively attained its primary goals of early intervention and reduction of incidents. Further investigations on the use of restraining bands and intervention with psychotropic drugs are needed.”