(024) Psychiatric Treatment of the Medically Complex Patient: An Overview of the Primary Psychiatric Service on a Medical/Surgical Unit

Abstract: In most hospitals in the United States, inpatient psychiatric units are not equipped to accommodate medically complex patients. To address this problem, Kern Medical hospital in Bakersfield, California implemented the primary psychiatry service (PPS) that is complementary to the 24-bed psychiatric unit and the psychiatric consultation and liaison service. PPS facilitates care to patients who meet criteria for inpatient psychiatric hospitalization but are not eligible for admission to the inpatient psychiatric unit due to medical requirements.

With PPS, patients are admitted to the medical/surgical floor under primary management of the consultation liaison psychiatry team. Additional care is provided by medical/surgical nursing staff previously trained by the psychiatry department, attending psychiatrist, psychiatry residents, and consulting physicians. A protocol for admission includes patients on a legal psychiatric hold or under voluntary psychiatric hospitalization who also have concurrent acute psychiatric and chronic medical conditions that are not suitable for the inpatient psychiatric unit. Primary psychiatry admission is approved by the attending psychiatrist and insurance. Some of the funding for patients admitted to PPS is provided by Kern County’s Behavioral Health and Recovery Services through the Mental Health Services Act.

As a result of this service, Kern Medical admitted 49 patients to PPS in 2021. The main diagnoses of primary-psychiatric-eligible patients were mood disorders, psychotic disorders, and disorders related to substance use. The most common medical conditions requiring admission to PPS were for impaired ambulation and COVID-19 infection requiring isolation. Additional data will be included in the poster.

The primary psychiatric service has been helpful with providing acute psychiatric care to medically compromised patients and has facilitated the flow of psychiatric patients within the emergency department. Being able to finance such protocols can be challenging as well, but the benefits are innumerable. There are potential challenges that can arise in such systems, including issues with medical complications and potentially lengthy disposition. Overall, from our single center experience it has been quite positive. Whether this novel system can be replicated in other centers effectively would be an area for further evaluation.

Hussain M, Seitz D. Integrated models of care for medical inpatientswith psychiatric disorders: a systematic review. Psychosomatics. 2014 Jul-Aug;55(4):315-325. doi: 10.1016/j.psym.2013.08.003. Epub 2014 Apr 13. PMID: 24735866.

Kathol RG, Kunkel EJ, Weiner JS, McCarron RM, Worley LL, Yates WR, Summergrad P, Huyse FJ. Psychiatrists for medically complex patients: bringing value at the physical health and mental health/substance-use disorder interface. Psychosomatics. 2009 Mar-Apr;50(2):93-107. doi: 10.1176/appi.psy.50.2.93. PMID: 19377017.





Learning Objectives:

-Awareness of an alternative model of psychiatric care to the traditional inpatient psychiatric setting

- List benefits and challenges to having a psychiatric primary service as part of the consultation liaison service

- Identify key patient diagnoses that one may encounter from psychiatric primary service