Understanding the scope of Consultation-Liaison Psychiatry referrals in a general hospital setting in New Zealand

Abstract

AIMS AND HYPOTHESIS To characterise and understand the scope of referrals made to a consultation-liaison psychiatry (CLP) service at Auckland, New Zealand which encompasses two general hospital campuses. While such work has been undertaken in other countries including the UK, USA, Australia and Italy, such work has not been previously undertaken in New Zealand. BACKGROUND The 24/7 CLP service receives referrals for a variety of acute and non-acute assessments from the Emergency Department (ED), wards, intensive care unit and outpatient clinics. The total inpatient bed-capacity across both hospital campuses is 953 beds with a variety of medical, surgical, obstetric and other disciplines on-site. The CLP service at Waitemata is multidisciplinary and consists of consultants, clinical psychologists, registrars and nurses. Waitemata serves a catchment area of 600,000 people and is the largest district health board in the country. METHODS This is a retrospective observational study that involved analysis of all referrals (n=1,000) made to the CLP service at Waitemata district health board over a 6-month timeframe (from November 1st 2017). Descriptive statistics were summarised for demographic variables and features of referrals, assessment and intervention. Data sources included electronic patient record systems for both physical and mental health services respectively. RESULTS Referrals were received for all age groups with 78% for those between the ages of 18-65 and 22% for those over the age of 65. Approximately 80% of referrals were for individuals who had a pre-existing mental illness and 40% of referrals were regarded as urgent. A minority of patients were from outside the catchment area (10%). The ED was the largest user of the service (approximately 66%). The main reasons for referral were self-harm/suicidal ideation (40%), mood disorder (8%), adjustment disorder (6%) or staff support (6%). The most common interventions offered by the CLP service was medication advice, risk or decision-making capacity assessments, psychotherapy, psychoeducation for patients/staff, recruitment of other services (e.g. social worker, addiction services) and legal advice. CONCLUSIONS The results highlight the diversity of CLP input with a large demand for acute assessment at the ED. Although largely adults of working age were seen, a significant minority were elderly, and a small proportion were from outside the catchment area which has implications for optimal service funding and delivery. Future work is also required to examine services elsewhere.