(012) "Why the Capacity Consult?": Drivers of Hospitalists’ Utilization of Psychiatry Consultations to Determine Patient Medical Decision-Making Capacity

Abstract: Background: Research points to high volume and varying benefits of routine psychiatric consultation to determine medical decision-making capacity (DMC). Factors contributing to these requests have not been studied. We surveyed general medicine hospitalists to understand their most common reasons for requesting DMC assessments.

Methods: Twenty-six hospitalists at a regional, tertiary-care academic hospital completed a 7-item survey, using a 5-point Likert scale rating their reasons for requesting DMC consults (1-least common to 5-most common). Rating score frequencies, means, standard deviations, medians, and associations between responses were analyzed.

Results: The two most common reasons for requesting psychiatric consultation for DMC determinations, an Underlying Psychiatric/Neurocognitive Diagnosis (m=4.40, SD=0.65, Mdn=4) and High Stakes Decision (m=4.16, SD=0.80, Mdn=4; r=0.44, p< 0.05). Requested by Risk Management (m=3.92, SD 0.93, Mdn= 4) and Requested by Social Work (m=3.92, SD=0.93, Mdn=4) were as ≥ 4 by >75% of respondents (i.e. 5= most common; r=0.48, p< 0.05). Over 60% of respondents rated To Protect Myself Legally (m=3.50, SD=1.14, Mdn=4) ≥ 4, which was correlated with Low Confidence (m=2.58, SD=0.95, Mdn=3) (r=0.49, p < 0.05).

Conclusions: This study points to several important drivers of routine psychiatry consultations for DMC assessments, including requests by social workers and risk managers, and perceived legal protection. Further research to replicate and characterize these drivers may inform education and guidelines that empower staff to resolve lower risk DMC questions and focus utilization of limited psychiatry resources towards high-complexity, high-risk cases with strong, expected benefit.

Presenting Author(s)

Mansi Chandra, BA (she/her/hers)

Medical Student
Renaissance School of Medicine at Stony Brook University
Stony Brook, NY, United States

Co-Author(s)
CC

Cynthia Cervoni, PhD

Clinical Assistant Professor
Stony Brook University
Stony Brook, New York, United States

RL

Rachel Luba, Doctorate

Postdoctoral Research Fellow
New York State Psychiatric Institute
New York, New York, United States

Zubair Ali, MD

CL Psychiatrist
Northwell Health
Woodbury, New York, United States

SA

Sadia Abbasi, MD

Chief of Hospital Medicine, Stony Brook University Hospital
Stony Brook University Hospital
Plainview, New York, United States

Brian Bronson, MD

Clinical Professor and Vice-Chair
Department of Psychiatry & Behavioral Health at Stony Brook University
Stony Brook, New York, United States