Hospitalists nationwide are faced with complex patient and family behaviors that interfere with medical care. In the acute inpatient setting, few resources are available for physicians to address maladaptive behaviors and many physicians report significant discomfort managing these disruptive behaviors. We implemented a Nurse Practitioner-Led Psychiatric Consult Service to provide education and recommendations for providers caring for patients whose behaviors threaten care and safety.
Purpose:
Our goals were to resource providers to manage disruptive behaviors of patients and families, and to assess the impact of this service on physician and staff satisfaction, and confidence in recognizing and managing difficult behaviors.
Description:
The nurse consult liaison was available to providers from May 2015 to November 2015 via an EMR-based consult and via paging website. This service, distinct from the traditional consult psychiatry model, aimed to provide all healthcare staff with education and recommendations for de-escalating patients whose behaviors compromised care on 3 medical-surgical adult units.
Pre- and post-implementation surveys using a five-point Likert scale were sent to a convenience sample of providers regarding their attitudes, perceived comfort level and subjective strengths/weaknesses when managing complex behaviors. Fifty providers responded in the pre-survey and 26 providers responded to the post-survey. For this analysis, responses were collapsed into dichotomized categories (i.e., very adequate/adequate and somewhat/minimally/not at all adequate). Quantitative data was analyzed by bivariate comparison utilizing Chi squared or fisher’s exact tests as appropriate (Table 1). Qualitative data was analyzed using thematic identification.
Pre and post intervention analysis of qualitative data revealed that notably more staff members were satisfied with the available resources for managing complex behavioral patients after implementation of this service. Statistically significant changes in resources and education that collectively impacted clinical practice were seen in multiple domains, the most pertinent of which are outlined in Table 1. The majority of respondents were satisfied with the service and felt previously unmet needs were frequently addressed by involving the psychiatric nurse practitioner.
Conclusions:
The implementation of a Nurse Practitioner-Led Psychiatric Consult Service at our institution has improved hospitalist perception regarding available resources, comfort in the management of psychiatric symptoms as well as PRN medication use based on patient behavior. Due to the substantial impact of this service on providers’ satisfaction, as evidenced by positive feedback regarding this beneficial service model, it has now been expanded to 5 units.