BACKGROUND Proactive consultation-liaison psychiatry improves identification of psychiatric needs and reduces time to psychiatric consultation and length of stay (LOS) among medical inpatients in academic clinical settings. OBJECTIVE To evaluate the effect of a proactive model on LOS, consult rate, and consultation latency in a nonacademic community hospital. METHODS We implemented a modified proactive consultation-liaison service (PCS) in a 32-bed acute care medical-surgical unit in a community hospital. We compared outcomes during a 90-day PCS intervention period to preintervention and postintervention cohorts receiving consultation-as-usual in the same unit. During the intervention, a psychiatrist reviewed the electronic medical record of patients admitted to the study unit to guide recommendations and collaborated with existing unit staff. Primary outcomes were LOS, consultation rate, and consultation latency. Secondary outcomes included restraint utilization, 1:1 companion utilization, and a survey completed by unit nursing staff. RESULTS Half of patients on the study unit had psychiatric comorbidity. Median LOS in the PCS cohort was 3.0 days versus 5.0 days in the preintervention and postintervention cohorts. The consultation rate was higher in the PCS cohort (1.4% before intervention; 33% intervention; 6.5% after intervention), and median consultation latency was also reduced during the intervention (57.6 h before intervention; 19.2 h intervention; 48 h after intervention). CONCLUSIONS Implementation of a modified PCS model is feasible in a community hospital setting and can reduce LOS, enhance psychiatric service utilization, and reduce consultation latency. This study demonstrates that proactive consultation-liaison may offer the same benefits to nonacademic community hospitals as it does to large academic centers.

中文翻译：

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超出学术医院环境的主动 CL 精神病学：郊区社区医院有效性的试点研究。

背景主动咨询联络精神病学提高了对精神病学需求的识别，并减少了学术临床环境中内科住院患者的精神病学咨询时间和住院时间（LOS）。目的 评估主动模式对非学术社区医院的 LOS、就诊率和就诊延迟的影响。方法 我们在一家社区医院的 32 个床位的急症护理内外科实施了改进的主动咨询联络服务 (PCS)。我们将 90 天 PCS 干预期间的结果与在同一单位照常接受咨询的干预前和干预后队列进行了比较。在干预期间，精神科医生审查了进入研究单位的患者的电子病历以指导建议并与现有单位工作人员合作。主要结果是 LOS、会诊率和会诊延迟。次要结果包括约束使用、1:1 同伴使用和由单位护理人员完成的调查。结果 研究单位的一半患者患有精神疾病。PCS 队列的中位 LOS 为 3.0 天，而干预前和干预后队列为 5.0 天。PCS 队列的会诊率较高（干预前 1.4%；干预 33%；干预后 6.5%），干预期间的中位会诊潜伏期也减少（干预前 57.6 小时；干预 19.2 小时；干预后 48 小时） . 结论 改进的 PCS 模型在社区医院环境中的实施是可行的，并且可以减少 LOS，提高精神科服务的利用率，并减少咨询延迟。