(151) Psychiatry Consult Order to Include Capacity

Abstract:

Introduction:
Psychiatry consult requests for capacity evaluations frequently do not specify the medical decision for which capacity is being requested. A common misconception regarding capacity is that it is “all or none”, applying to all medical decisions. Our goal for the study was to see if amending the psychiatry consult order to include specific information relating to capacity would facilitate better communication between the primary team and the consulting psychiatrist.

Design:
We screened all psychiatry consult orders, at a university teaching hospital, Jersey Shore University Medical Center, prior to the order change (June and July 2020), to determine what percentage of consults intended for capacity evaluation actually stated “capacity”, and what percentage of these consults specified for what decision capacity evaluation was being requested. We did the same for the months of September through December 2020, post psychiatry order revision and additionally included the percentage of capacity order requests that also stated that the risks and benefits of recommended medical or surgical treatment involving this decision was discussed with the patient. We then sent surveys to JSUMC medical and surgical staff to evaluate if utilizing this revised psychiatry order set enabled them to gain a better understanding.

Results: Post psychiatry consult order revision we aimed for a 20% increase in the number of psychiatry consults for capacity evaluation that stated the consult is for “capacity,” a 20 % increase in the number of consults that provided information regarding the specific decision for which capacity in question. We aimed for at least 30% of capacity consultations post psychiatry order revision to state whether the risks and benefits of recommended medical or surgical treatment involving this decision was discussed with the patient.
Prior to the psychiatry consult order change, 17% (9 out of 53) consult orders specified the reason for capacity consult. Post implementation, 66% (66 of 99 consults orders) of capacity consults specified the type of decision. Additionally, post implementation 72% (71 of 99) orders specified that the consult type was a capacity consult and 59% (58 of 41) reported that they had already discussed the risks and benefits of the decision with the patient prior to the psychiatry consult.

Conclusion:
As a whole, we were found that by making the aforementioned changes to the psychiatry consult order form in the electronic medical record, we were able to facilitate significant improvement in interdepartmental communication between the primary team and the consult service.

Presenting Author(s)

Andrew Spaedy, MD

Child and adolescent psychiatry fellow
Jersey Shore University Medical Center
Neptune, NJ, United States

Co-Author(s)
AF

Adriana Fitzsimmons, MD

Psychiatry Consultation Liaison Director
Jersey Shore University Medical Center
Neptune, New Jersey, United States

SK

Shveta Kansal, MD

Child and adolescent psychiatry fellow
Jersey Shore University Medical Center
Neptune, NJ, New Jersey, United States