Do Old Habits Die Hard? Incorporating Up-To-Date Evidence-Based Clinical Practices in Consultation-Liaison Psychiatry and Helping to Inspire Transformations in Care Through Education

Abstract:

Introduction: Multiple barriers prohibit quick incorporation of evidence-based practices into clinical care, with the delay for a new discovery to travel from bench to bedside cited as seventeen years. Like many hospital systems undergoing horizontal integration, our institution’s consultation-liaison (CL) psychiatry service has expanded to cover nine hospitals, necessitating CL nurses, clinicians, and physicians with inevitable differences in training to provide uniform evidence-based care. Our service created and disseminated institution-specific CL best practices guidelines to address this need. Our aim was to enhance evidence-based practices and track changes in knowledge, comfort, and attitudes pre- and post- creation and dissemination of clinical guidelines on catatonia, substance use disorders, trauma, and agitation.

Methods: Guidelines were created in a uniform manner including review of Pubmed/Google Scholar/national guidelines, creation of guidelines using a template, assignment of strength of evidence/level of recommendation, internal and external peer review, and revision/finalization. Guidelines uploaded to an electronic portal were disseminated through CL Grand Rounds and electronic communication. Pre- and post-surveys were disseminated prior to guideline creation and after guideline distribution.

Results: 47 unique multidisciplinary providers participated in the pre- and post-survey – 27 completed only the pre-survey, 7 completed only the post-survey, 13 completed both surveys. 65% were 25-44 years of age, 56% female, 78% White/Caucasian.

When asked if “best practice guidelines are a valuable tool for clinical practice,” the percentage of respondents who strongly agreed increased from 47.5% pre-survey to 80% in the post-survey.

A higher percentage of overall participants chose the correct answer in the post-survey for 3 knowledge-based questions. These increases were, by topic: catatonia (70% to 90%), trauma (40% to 80%), agitation (22.5% to 35%).

Post-survey respondents reported higher comfort levels in providing evidence-based care. Only 15% of pre-survey participants reported being very or extremely confident utilizing second and third line treatments of catatonia; compared to 40% post-survey. In the pre-survey, 17.5% were very or extremely confident in utilizing national agitation protocols; this number increased to 45%.

No participant reported any guideline as being “not so useful” or “not at all useful.” Over 90% of all participants reported that they are likely to use each of the guidelines.

Discussion: Our initiative shows that internally developed clinical practice guidelines can improve knowledge, attitudes, and comfort. Guidelines address disparities in clinical training, allow for consistent care in novel care settings, and facilitate trainee education. The process workflow creation, survey results, sample guidelines, and utilization data will be presented; attendees will leave with practical tools for guidelines implement in their home institution.

Conclusion: Large CL services with multiple sites can consider creation of best practice guidelines to improve their team's knowledge, attitudes, and comfort with general topics pertaining to CL psychiatry.