(144) Communication of Recommendations Between Inpatient Psychiatric Consultation and Outpatient Primary Care

Abstract: Background

Psychiatry consultation involves specialized and thorough diagnostic evaluation and treatment. However, linkage to outpatient psychiatric care is limited by multiple factors, and many patients likely rely on their primary care physicians for follow up and management. The limited available literature on communication between subspecialty and primary care at hospital discharge suggests a perceived benefit and enhanced continuity of care (1-3), particularly with electronic health records (4). This study will assess the utility of automated electronic communication between academic consultation liaison psychiatry and outpatient primary care physicians.

Methods

We will analyze objective chart review data and subjective survey data to assess the need for improved communication between CL Psychiatry and primary care. The chart review will include a sample of patient charts used to estimate the proportion of patients seen by CL Psychiatry whose PCPs are within the same hospital system; the approximate rates of post-discharge follow-up; and the adherence to CL recommendations. The survey will be developed collaboratively with input from psychiatry and primary care quality teams and then distributed to primary care physicians affiliated with the central region of an academic tertiary care institution. The survey will include quantitative (Likert-scale) and qualitative data assessing PCPs’ perceptions of a) knowledge of inpatient psychiatric consultations for their patients, b) the barriers to continuity of psychiatric care/recommendations, and c) the value of notification of consultation via the EMR.

Results

Data collection and analysis will be completed prior to poster submission. We will outline the data regarding PCP follow-up from CL consultation and describe the response rate and aggregated responses to survey questions. Further opportunities for electronic notification of psychiatric consultation will be explored.

Discussion

We will discuss the need for a notification system to inform primary care physicians when their patients receive a psychiatric consultation in the hospital. We will highlight the impact on continuity of care, such as the enactment of psychiatric recommendations, in the outpatient setting. The findings of this needs assessment will inform the next steps of a larger quality improvement study, which aims to further strengthen quality initiatives between psychiatry and primary care (e.g. collaborative care).


References

< 1. Rigatelli M, et al. A Follow-Up Study of Psychiatric Consultations in the General Hospital: What Happens to Patients after Discharge? Psychother Psychosom 2001;70:276-282.

< Watanabe-Galloway S, et al. How to Transition Patients Back From Psychiatric Care to Primary Care: An Access Initiative Protocol Development. Psychiatr Serv. 2021; Epub ahead of print.

3. O’Malley AS, Reschovsky JD. Referral and Consultation Communication Between Primary Care and Specialist Physicians: Finding Common Ground. Arch Intern Med. 2011;171(1):56–65.

4. Colaiaco B, et al. Continuity of Information Between Mental Health and Primary Care Providers After a Mental Health Consultation. Psychiatr Serv. 2018 Oct 1;69(10):1081-1086.2