Proactive Psychiatric Consultation and Hospital Length of Stay in Adults: A Review of the Literature

Abstract

According to a 2022 systematic review on the prevalence of psychiatric disorders in general hospitals, it was estimated that approximately one-third of medical inpatients present with a coinciding psychiatric condition. However, other studies have reported that a low rate of patients actually obtain an inpatient psychiatric consult; and even fewer patients receive a consultation when it would not be traditionally indicated. Therefore, we have seen an emergence of the use of Proactive Consultation-Liaison (C-L) Psychiatry across many hospital settings. This model of care utilizes systematic screening for active mental health concerns, proactive interventions tailored to individual patients, team-based delivery, and care integration with primary services to provide psychiatric consultation earlier. This study conducted a focused PubMed search to review the research to date on proactive C-L psychiatry and its impact on hospital length of stay (LOS) in patients over 18 years old. Results show a consequential reduction in average hospital LOS when proactive C-L psychiatry services are used compared to reactive, on-request consultation services. A shortened LOS is seen with this practice when there is a quicker time for consultation or referral. Thus, there is evidence of proactive C-L psychiatry’s success in decreasing average hospital LOS and improving patient care. Additional studies are necessary to determine its significance, as little research to date has been completed on the topic. It is recommended to expand the scope of investigation to different patient populations, including but not limited to pediatrics and patients without an underlying mental health illness.