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From Department of Psychiatry (P.d.J., C.H.M.L., F.J.H.), VU Medical Center, Amsterdam, The Netherlands and Department of Psychiatry (P.d.J.), University of Groningen, Groningen, The Netherlands.
Address correspondence to Peter de Jonge, PhD, Department of Social Psychiatry, Hanzeplein 1, Gebouw 32, P.O. Box 30.001, 9700RB Groningen, The Netherlands. E-mail: p.de.Jonge{at}med.rug.nl
OBJECTIVE: The authors investigated the effects of implementing psychiatric interventions on a general medical ward by means of a stepped detection and treatment strategy conducted by a consultation–liaison (CL) nurse in terms of reducing length of hospital stay (LOS) and improving quality of life (QOL) at discharge.
MATERIALS AND METHODS: One hundred ninety-three patients participated in a controlled trial, in which patients were screened with COMPRI and INTERMED. A nurse under supervision of a CL psychiatrist conducted interventions, consisting of simple psychiatric interventions by herself, referral to auxiliary services, or initiation of postdischarge care. Intervention patients were compared with historic controls on LOS and QOL (SF36) at discharge.
RESULTS: In multivariate analysis of variance, a significant effect of the intervention on QOL (p = 0.037) was found, which diminished after controlling for confounders (p = 0.28). No significant effect on LOS was found for the whole sample (p = 0.72), but in patients age 65 years or older, a reduction in LOS (p = 0.05) was found. This effect remained after controlling for confounders (p = 0.06).
CONCLUSIONS: These data suggest that screening for risk of increased health care might improve outcomes in general medical inpatients. Because of the design of the study, however, these findings should be considered preliminary and confirmed in a larger, multicenter, randomized controlled trial.
Key Words: internal medicine, • psychiatry, • LOS, • health status, • quality of life.
Abbreviations: LOS = length of stay;; QOL = quality of life;; CL = consultation–liaison;; SF36 = medical outcomes study short form 36;; COMPRI = complexity prediction instrument;; INTERMED = interdisciplinary medicine.
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