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Timing of Psychiatric Consultations

The Impact of Social Vulnerability and Level of Psychiatric Dysfunction

Received January 14, 2000; revised April 3, 2000; accepted June 28, 2000. From Psychiatry Service, Vrije Universiteit Hospital, Amsterdam, The Netherlands; Service of Liaison Psychiatry, University Hospital, Lausanne, Switzerland; Psychiatry Department, Northwestern University, Chicago, Illinois; and General Internal Medicine, University of Groningen Hospital, Groningen, The Netherlands. Address correspondence and reprint requests to Dr. de Jonge, Psychiatrische Consultatieve Dienst, Academisch Ziekenhuis der Vrije Universiteit, Postbus 7057, 1007 MB Amsterdam; e-mail: p.dejonge{at}azvu.nl

The authors examined the timing of patient referrals to a psychiatric consultation-liaison service in relation to the patient's social vulnerability and level of psychiatric dysfunction. One hundred consecutive patients were assessed with the INTERMED, a method to document biopsychosocial and health care-related aspects of disease. Although 30% of patients were referred within the first day of admission, 19% of requests for referrals were made after 2 weeks. Late referral was associated with high social vulnerability and early referral with severe psychiatric dysfunction. The authors illustrate the disadvantages of a psychiatric liaison model focusing on psychopathology alone and demonstrate the need for an integrated patient assessment in the general hospital, focusing on detecting frail elderly patients.

Key Words: INTERMED • referral time

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