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Low-dose Lithium Treatment for Agitation and Psychosis in Alzheimer Disease and Frontotemporal Dementia: A Case Series [Case Report]

Devanand, Davangere P; Pelton, Gregory H; D'Antonio, Kristina; Strickler, Jesse G; Kreisl, William C; Noble, James; Marder, Karen; Skomorowsky, Anne; Huey, Edward D
PMID: 27819842
ISSN: 1546-4156
CID: 4490542

Co-managed Care for Medical Inpatients, C-L vs C/L Psychiatry

Muskin, Philip R; Skomorowsky, Anne; Shah, Ravi N
OBJECTIVE:We report on a quality improvement program to co-manage patients with co-morbid medical and psychiatric disorders in the general hospital. A philanthropic donation allowed a high volume, high-acuity urban hospital to hire a co-managing inpatient psychiatrist. The expectation was that facilitating psychiatric evaluation/treatment of medical patients would result in fewer patients staying beyond the expected length of stay (LOS). METHOD:The psychiatrist became a member of a general medical team working with a group of internists and actively co-managing medical patients. After one year, we compared time-to-consultation request and LOS for patients seen through the traditional Consultation-Liaison model and patients seen through the co-managed care model. A second co-managing psychiatrist was hired. A new QI project investigated reduction in lost days. RESULTS:There was a decrease in LOS for patients seen in the co-managed care model when compared with those seen via the traditional Consultation-Liaison model. Co-managed patients were seen earlier in the hospitalization. Excluding very-long-stay outliers, there was a reduction in LOS of 1.19 days (p < 0.003). There was an estimated annualized saving to the hospital of 2889 patient days. CONCLUSIONS:A program of co-managed care reduced both LOS and lost days to the hospital. This resulted in an increase in hospital support to hire 2.5 full-time equivalent psychiatrists and 1.0 full-time equivalent social worker for the Consultation-Liaison service. Such programs may permit the return of modernized psychiatric liaison programs to medical and surgical services.
PMID: 27039157
ISSN: 1545-7206
CID: 4490532