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Psychiatric Consultations and Length of Hospital Stay

TO THE EDITOR: Yasuhiro Kishi, M.D., and colleagues¹ provided an important update by using relatively recent data on the relationship between the timing of psychiatric consultations and the length of hospital stay. Several notes of caution regarding their findings are important and stem from earlier work in this area.^2,3 The relationships among variables remain associations, and it is entirely possibly that unmeasured factors associated with the request for consultation might independently be related to the length of stay or that the direction of inference is reversed. That is, certain patterns of clinical need associated with delayed discharge may more likely become apparent later in the hospital stay (e.g., placement problems). Acute medical complications requiring psychiatric consultations can occur late as well as early in the hospital stay, and when they do, it is likely that a psychiatric consultation (not necessarily "delayed") would uncover problems needing further assessment and intervention. Thus, it may not be entirely correct to assume that these are "delayed consultations" or that these patients experience "poor outcomes" as a result.

Nonetheless, the notion of focusing to a greater extent on identifying at-risk individuals in the denominator of patients in a hospital rather than passively waiting for an arbitrary numerator of psychiatric consultation requests to come forward is a wise strategy for improving patient care.

REFERENCES

1. Kishi Y, Meller WH, Kathol RG, Swigart SE: Factors affecting the relationship between the timing of psychiatric consultation and general hospital length of stay. Psychosomatics 2004; 45:470–476[Abstract/Free Full Text]
2. Marcus SE, Pincus HA, Goldman HH, Wallen J: Factors associated with the use of psychiatric consultations in short-term general hospitals. Psychosomatic Med 1987; 49:508–522[Abstract/Free Full Text]
3. Wallen J, Pincus HA, Goldman NH, Marcus SE: Psychiatric consultations in short-term general hospitals. Arch Gen Psychiatry 1987; 44:163–168[Abstract/Free Full Text]

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