(145) Developing an Algorithm to Clarify Consult Questions for UCSF C/L Psychiatry

Abstract:

Background: Clarifying the consult question has been a longstanding issue across medical specialties including C/L psychiatry. Research in other specialties has shown that consultants do not share the same understanding as the primary team about the consult question in 15% of cases and ignore the question altogether in 12% of cases (Goldman et al., 1983). For C/L psychiatry at UCSF, clarifying the consult question is similarly problematic and results in numerous inefficiencies. At best, we spend signficant time clarifying questions, many of which can be answered with simple education about our particular service/hospital or are otherwise not appropriate for C/L psychiatric evaluation. At worst, this process can create confusion within the C/L psychiatry team or tension between our team and the primary one, especially as there is limited shared understanding of appropriate consult questions. Given the time constraints of the C/L psychiatry service, developing (and ultimately embedding into our EMR) an algorithm to clarify consult questions could increase efficiencies for both C/L psychiatry and primary team work flows as well as further our “liaison” priorities.

Methods: From May to June 2022, we will iteratively develop an algorithm to clarify and track consult questions posed to the UCSF C/L psychiatry service. The UCSF C/L psychiatry service provides inpatient psychiatric consultation to primary teams across three hospitals (UCSF Medical Center at Parnassus, UCSF Medical Center at Mount Zion, and UCSF Medical Center at Mission Bay).

Results: Our results will include 1) a visual depiction of the developed algorithm, 2) the types and percentages of consult questions that could and could not be clarified, and 3) commentary on barriers to algorithmic clarification and lessons learned.

Discussion/

Conclusion: Iterative development of the above algorithm may allow for efficient clarification and tracking of consult questions for the UCSF C/L psychiatry service, ultimately aiding in automation of these process.

References: Goldman, L., Lee, T., Rudd, P. (1983). Ten commandments for effective consultations. Archives of Internal Medicine, 143 (1753-1755).