Consultation-liaison psychiatry services: Difference in the patient profile while following different service models in the medical emergency

AIM: To compare “consultation” and “hybrid” models of consultation-liaison (CL) services provided to patients visiting the medical emergency outpatient services. MATERIALS AND METHODS: Over the period of 18 months, two different models of consultation psychiatry services (July 2012 to March 2013-consultation model, April 2013 to December 2013 hybrid model) were compared. In the consultation model, the psychiatry resident was available on call to the internists. Whereas, for the hybrid model psychiatry resident was stationed in the medical emergency and was available to assess the patients directly requiring psychiatric evaluation. RESULTS: During the first 9 months, 22,000 patients were evaluated in various emergency medical outpatient services, of which 383 (1.74%) were referred to the on-call psychiatry CL team. However, when the hybrid model was followed, the number of patients evaluated by the psychiatry resident increased to 594 out of 24,737 patients (2.4%) who reported to the emergency during the next 9 months period. There was a substantial increase in the proportion of cases with medical illnesses for which psychiatric consultation was sought, and a change in psychiatric diagnostic profile was observed too. When compared to the consultation model, the hybrid model was associated with greater use of medications, investigations, referrals and psychological measures in the emergency setting itself. CONCLUSIONS: Following a hybrid model in the medical emergency leads to an increase in the number of total psychiatric consultations and more extensive management of patients.