Background: Mental illness correlates with an increased length of stay (LOS) for patients hospitalized for medical conditions. While psychiatric consultations help manage mental illness among those hospitalized for medical conditions, consultations initiated by nonpsychiatric mental disease may lack maximum effectiveness. Methods: In a before-and-after design, in 2 contiguous years LOS for internist-initiated, conventional consultation (CC) as usual treatment was compared to LOS of a proactive, mental health professional-initiated, multidisciplinary intervention delivered by the behavioral intervention team (BIT) on the same units. The patient populations included general medical patients with a variety of illnesses. Patients were treated in 3 different inpatient settings with a total capacity of 92 beds serving 15,858 patient visits over 3 comparison years. BIT comprised a psychiatrist, a nurse, and a social worker, each of whom performed the specific tasks of their professional discipline, while collaborating among themselves and their health-care colleagues. BIT provided timely, appropriate, and effective patient care alongside consultative advice and education to their corresponding professional peers. BIT was compared to CC on the outcome of LOS. Results: There was a statistically significant reduction of LOS favoring BIT over CC for patients with an LOS of <31 days which persisted while controlling for multiple co-morbid factors. Also, a statistically significant spillover effect was suggested by the overall improvement of LOS on units implementing BIT. Conclusion: BIT is a promising means of lowering LOS on general medical units while providing a high level of care and staff support.

Silverstone PH: Prevalence of psychiatric disorders in medical inpatients. J Nerv Ment Dis 1996;184:43-51.
Wancata J, Windhaber J, Bach M, Meise U: Recognition of psychiatric disorders in nonpsychiatric hospital wards. J Psychosom Res 2000;48:149-155.
Saravay SM: Psychiatric interventions in the medically ill. Outcome and effectiveness research. Psychiatr Clin North Am 1996;19:467-480.
Bourgeois JA, Kremen WS, Servis ME, Wegelin JA, Hales RE: The impact of psychiatric diagnosis on length of stay in a university medical center in the managed care era. Psychosomatics 2005;46:431-439.
Gallagher TH, Levinson W: A prescription for protecting the doctor-patient relationship. Am J Manag Care 2004;10:61-68.
Morgan JF, Killoughery M: Hospital doctors' management of psychological problems - Mayou & Smith revisited. Br J Psychiatry 2003;182:153-157.
Zolnierek CD: Non-psychiatric hospitalization of people with mental illness systematic review. J Adv Nurs 2009;65:1570-1583.
Tabet N, Hudson S, Sweeney V, Sauer J, Bryant C, Macdonald A, Howard R: An educational intervention can prevent delirium on acute medical wards. Age Ageing 2005;34:152-156.
Hansen MS, Fink P, Frydenberg M, Oxhoj ML, Sondergaard L, Munk-Jorgensen P: Mental disorders among internal medical inpatients - prevalence, detection, and treatment status. J Psychosom Res 2001;50:199-204.
Kishi Y, Meller WH, Kathol RG, Swigart SE: Factors affecting the relationship between the timing of psychiatric consultation and general hospital length of stay. Pschosomatics 2004;45:470-476.
Boone CR, Coulton CJ, Keller SM: The impact of early and comprehensive social-work services on length of stay. Soc Work Health Care 1981;7:1-9.
Lyons JS, Hammer JS, Strain JJ, Fulop G: The timing of psychiatric-consultation in the general-hospital and length of hospital stay. Gen Hosp Psychiatry 1986;8:159-162.
Farren EA: Effects of early discharge planning on length of hospital stay. Nurs Econ 1991;9:25-63.
Bourgeois JA, Wegelin JA: Lagtime in psychosomatic medicine consultations for cognitive-disorder patients: association with length of stay. Psychosomatics 2009;50:622-625.
De Jonge P, Latour CHM, Huyse FJ: Implementing psychiatric interventions on a medical ward: effects on patients' quality of life and length of hospital stay. Psychosom Med 2003;65:997-1002.
Tadros G, Salama RA, Kingston P, Mustafa N, Johnson E, Pannell R, Hashmi M: Impact of an integrated rapid response psychiatric liaison team on quality improvement and cost savings: the Birmingham RAID model. Psychiatrist 2013;37:4-10.
Harari D, Martin FC, Buttery A, O'Neill S, Hopper A: The older persons assessment and liaison team: OPAL evaluation of comprehensive geriatric assessment in acute medical inpatients. Age Ageing 2007;36:670-675.
Fulop G, Strain JJ, Fahs MC, Schmeidler J, Snyder S: A prospective study of the impact of psychiatric comorbidity on length of hospital stays of elderly medical-surgical inpatients. Psychosomatics 1998;39:273-280.
Wallen J, Pincus HA, Goldman HH, Marcus SE: Psychiatric consultations in short-term general hospitals. Arch Gen Psychiatry 1987;44:163-187.
Torem M, Saravay SM, Steinberg H: Psychiatric liaison: benefits of an ‘active' approach. Psychosomatics 1979;20:598-611.
Strain JJ, Lyons JS, Hammer JS, Fahs M, Lebovits A, Paddison PL, Snyder S, Strauss E, Burton R, Nuber G, Abernathy MA, Sacks H, Nordlie J, Sacks C: Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients. Am J Psychiatr 1991;148:1044-1049.
Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE: Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med 2007;35:1530-1535.
Sells D, Sledge WH, Wieland M, Walden D, Flanagan E, Miller R, Davidson D: Cascading crises, resilience and social support within the onset and development of multiple chronic conditions. Chronic Illn 2009;5:92-102.
Sledge WH, Wieland M, Sells D, Walden D, Holmberg C, Lin Z, Davidson L: Qualitative study of high-cost patients in an urban primary care centre. Chronic Illn 2011;7:107-119.
Stein MB, Cox BJ, Afifi TO, Belik SL, Sareen J: Does co-morbid depressive illness magnify the impact of chronic physical illness? A population-based perspective. Psychol Med 2006;36:587-596.
Levine J, Brown K, Chawarski M, Fiellin D, White W, Sledge W: Major depression and recent physical or sexual abuse increase readmissions among high-utilising primary care patients. Ment Health Fam Med 2008;5:23-28.
Desan PH, Zimbrean PC, Weinstein AJ, Bozzo JE, Sledge WH: Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team. Psychosomatics 2011;52:513-520.
Kathol RG, Perez R, Cohen JS: The Integrated Case Management Manual: Assisting Complex Patients Regain Physical and Mental Health. New York, Springer Publishing, 2010.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.