(175) Creating Operational and Safety Metrics for a Consultation-Liaison (C-L) Psychiatry Service

Abstract:

Background: Data that demonstrates productivity, value or quality in clinical practice are high priority in healthcare systems but are less developed for the field of C-L Psychiatry. Recent work has focused on qualitative metrics (Kovacs et al., 2021) and service effectiveness (Wood, et al., 2014) but there is no consensus on what operational or safety metrics CL teams should track. Without reliable metrics, it can be challenging to illustrate daily CL service operations or provide quantitative support to justify expansion of staffing to hospital leadership. In response to an administrative need, our service started an ongoing collaboration with departmental leadership, administrative support staff, and medical center information technology to develop CL operational and safety metrics.

Methods: We developed 17 monthly and 9 daily metrics to describe our operations. These metrics cluster into the following groups: clinical volume and encounters; behavioral emergency response activations (BERTs) and bedside safety huddles for patients with recent violence; length of stay; proactive Addiction CL service; behavioral acuity highlights (ex: 1:1s for suicide risk); and “CL Dwell Time” which is the time from medical clearance to discharge to inpatient psychiatry (if applicable). From this data, we selected key metrics to display on a quarterly basis to senior hospital leadership in the form of a “metrics card” to parallel our medicine and surgical colleagues who present High Reliability Organization score cards.

Results: Our service demonstrated increases in consultation requests, completed consultations, total clinical encounters and activation of BERTs. We compared trends for total length of stay by ultimate discharge destination, such as psychiatric admission vs acute rehabilitation vs home. The data allowed for deeper dives into concerning trends, such as the problem of escalating violence in the general medical hospital as evidenced by the increasing BERTs per month over several years. We examined the number of unique patients with BERTs, BERTs per patient, BERTs per patient by psychiatric diagnoses, and BERT total per medical unit or service. The data has allowed for the development of interventions to reduce BERTs for specific populations and medical units.

Discussion: The creation of comprehensive CL service operational metrics has provided our team with the ability to analyze clinical, acuity, and safety trends over the past 2 years. This ability has led to improved advocacy for service needs (i.e. expansion of FTE and fellowship lines), data-informed communication with hospital leadership, and identification of clinical care gaps needing quality improvement.

Ref:
1. Kovacs Z, Asztalos M, et al. Quality assessment of a consultation-liaison psychiatry service. BMC Psychiatry. 2021 Jun 1;21(1):281.
2. Wood R, Wand AP. The effectiveness of consultation-liaison psychiatry in the general hospital setting: a systematic review. J Psychosom Res. 2014 Mar;76(3):175-92.