Inpatient Obstetric Consults at A Large Academic Medical Center: Service Utilization and Targets for Quality Improvement

Abstract: Background/significance: Perinatal psychiatric disorders are common, with a 12-month prevalence of 25.3% and 27.5% for pregnant and postpartum women, respectively (Vesga-Lopez et al, 2008). Yet, most studies have shown low overall rates of consult liaison (CL) psychiatry consultation, despite high disorder prevalence (Rigatelli et al., 2002; Lin et al., 2011). This quality improvement (QI) study (1) determined the rate of inpatient obstetric service utilization of CL psychiatry and (2) characterized the consults on several variables at a large academic medical center with 7500 births annually.



Methods: Consult-liaison psychiatry consults at the Long Island Jewish Medical Center of Northwell Health initiated from the obstetric inpatient service in 2021 were identified from billing data. For each case, the chart was reviewed to qualitatively assess and categorize cases by clinical data. Qualitative and quantitative variables were evaluated including: age, psychiatric consult question, presenting symptoms, engagement with ambulatory psychiatric care, need for psychiatric inpatient admission, and whether a psychiatric symptom scale, either the Edinburgh Postnatal Depression Scale (EPDS) or the Patient Health Questionnaire (PHQ-9), was administered



Results: 63 consultations on unique pregnant or postpartum patients on the obstetric service were identified from January 1 through December 31, 2021, representing 0.84% of total births and less than 3% of total psychiatric consultations. The consultations were 11% antepartum and 89% postpartum with an average age of 31. 30% of patients were engaged in outpatient psychiatric care. 43% of consults were requested due to history of psychiatric symptoms rather than active symptoms, with 48% of those consults called due to history of suicidality followed by 26% for both history of bipolar disorder and history of other psychiatric diagnosis. 57% of consults were for active symptoms, and 44% of those had a psychiatric symptom scale documented in the EMR (EPDS: mean 8 ± 6; PHQ-9: mean 5±7). All consultations were cleared for discharge from a psychiatric perspective; none were psychiatrically hospitalized at the time of consultation.



Discussion/Conclusion: In line with published data, we identified a discrepancy between the prevalence rates of perinatal psychiatric disorders and the rates of CL psychiatry consultation to inpatient obstetrics services at our academic medical center. This data will support QI initiatives to improve perinatal psychiatric disorder detection and referral to CL psychiatry.



References:
Vesga-Lopez, O. et al. (2008) ‘Psychiatric disorders in pregnant and postpartum women in the United States’, Archives of General Psychiatry. Arch Gen Psychiatry, 65(7), pp. 805–815.

Lin, H. L. et al. (2011) ‘The role of consulting psychiatrists for obstetric and gynecologic inpatients’, Chang Gung Medical Journal. Chang Gung Med J, 34(1), pp. 57–64.

Rigatelli, M. et al. (2002) ‘Consultation-liaison psychiatry in obstetrics and gynecology’, Journal of Psychosomatic Obstetrics and Gynecology. Parthenon Publishing Group Ltd, 23(3), pp. 165–172.