(025) The relationship between severity of behavioral event and length of stay as mediated by time-to-referral and moderated by race

Abstract: Background/Significance:

Behavioral management and agitation are among the most common consults for consultation-liaison psychiatry (CLP) providers and contribute to adverse outcomes during and after a hospital stay. Timeliness to contact CLP significantly predicts length of hospital stay; however, previous literature does not consider the precipitating behavioral event that led to CLP involvement, nor does it consider patient’s race (Brunn, 2020; Wood, 2015). We hypothesize time-to-referral (TTR) mediates the relationship between severity of the event and length of stay, which is also moderated by race.

Methods:

The present study is part of a program development project with non-human subjects delineation. We will analyze data from a retrospective chart review (N=215) of patients admitted to a Level 1 Trauma Center with a documented safety/security incident. An independent rater blinded to demographic characteristics and hospitalization information completed the SOAS-RE and rated the severity (0-10) of each safety/security incident. TTR and length of stay is calculated using the methods described by Wood, et al. Race is extracted from the patient’s EHR. We will analyze data in ‘R’ using the processR package.

Results:

At time of submission, our team has limited data. We will be able to analyze and report the data by the October 2022 deadline. If we are not successful, we will withdraw our submission.

Discussion:

We aim to demonstrate that shorter TTR decreases length of stay for our patients, as explained by the severity of the behavioral event. Knowing this, we would advise implementing a proactive CLP team. This team can monitor patients based on potential predictive factors that may indicate a future severe behavioral event. This could result in better outcomes for the patient, and potentially prevent a behavioral event. We hypothesize that the relationship between TTR and length of stay changes based on the patient’s race. If observed, we may suspect bias leading to quicker but inappropriate early discharge.

Conclusion/Implications

This study will highlight the importance of making timely, proactive consults to the CLP team for patients who are likely to experience a behavioral event. We see a future in creating programming that includes CLP consults as a standard of care for trauma patients. This model may prevent later behavioral episodes, address healthcare disparities, improve staff and patient safety and patient outcomes. More research is needed to determine the effectiveness of such a program.

References:

1) Wood R, Wand AP, Hunt GE: Relationship between timeliness of contact and length of stay in older and younger patients of a consultation-liaison psychiatry service. BJPsych Bulletin. 2015;39(3):128-133. doi:10.1192/pb.bp.114.047340

2) Brunn M, Diefenbacher A, Strain JJ: Are there effects of consultation-liaison-psychiatry on length of stay in the general hospital? A path analysis. The European Journal of Psychiatry. 2020;34(4):195-201. doi:10.1016/j.ejpsy.2020.06.001

Presenting Author(s)

Kelsey Talty, n/a

Medical Student
University of Maryland School of Medicine
Baltimore, Maryland, United States

Co-Author(s)

Samantha Latorre, MD

Associate Program Director, Consultation-Liaison Psychiatry Fellowship
University of Maryland School of Medicine
Baltimore, Maryland, United States
MM

Madeline R. Marks, PhD

Assistant Professor
University of Maryland School of Medicine
Baltimore, Maryland, United States