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Psychiatric Consultations and Length of Hospital Stay

TO THE EDITOR: With interest, we read the article by Dr. Kishi et al., who reported on risk factors for delays in referral and its consequences in terms of length of hospital stay in a large sample of patients referred to consultation-liaison psychiatrists. We compliment the authors for conducting this work because it provides insights into the background characteristics of the population seen in consultation-liaison psychiatry and in the potential limitations of the current referral procedure. To a large extent, Dr. Kishi et al. replicated findings we presented before, i.e., that late referrals are seen in patients with relatively mild forms of psychopathology, such as no psychiatric diagnosis or adjustment disorder. Also, late referrals were associated with the diagnosis of depression and delirium, whereas suicidal ideation and/or behavior and drug-related disorders were more often seen in early referrals.

Among the possible explanations for these findings we offered then were the late occurrence of some psychiatric disorders (e.g., delirium) and the relative unobtrusiveness for the staff of some other disorders (e.g., depression and adjustment disorder). In a European research group (not a Dutch group, as mentioned by Dr. Kishi et al.), we therefore developed a method to help staff detect patients in need of referral to consultation-liaison psychiatry—the INTERMED (for further information, see http://www.vumc.nl/intermed). We would like to draw attention to a series of recent studies showing that high INTERMED scores are prospectively related to poor outcomes in several specific somatic diseases.^1–4 These studies show that in several patient groups, the INTERMED detects patients at risk, and this method can improve access to psychiatric care in somatic health care settings. Ongoing intervention studies will evaluate the potential benefit of timely interventions on targeted patients identified with the INTERMED.

REFERENCES

1. de Jonge P, Ruinemans GM, Huyse FJ, ter Wee PM: A simple risk score predicts poor quality of life and non-survival at 1 year follow-up in dialysis patients. Nephrol Dial Transplant 2003; 18:2622–2628[Abstract/Free Full Text]
2. Di Gangi Herms AM, Pinggera GM, De Jonge P, Strasser H, Sollner W: Assessing health care needs and clinical outcome with urological case complexity: a study using INTERMED. Psychosomatics 2003; 44:196–203[Abstract/Free Full Text]
3. Koch N, Stiefel F, de Jonge P, Fransen J, Chamot AM, Gerster JC, Huyse F, So AK: Identification of case complexity and increased health care utilization in patients with rheumatoid arthritis. Arthritis Rheum 2001; 45:216–221[CrossRef][Medline]
4. Fischer CJ, Stiefel FC, De Jonge P, Guex P, Troendle A, Bulliard C, Huyse FJ, Gaillard R, Ruiz J: Case complexity and clinical outcome in diabetes mellitus: a prospective study using the INTERMED. Diabetes Metab 2000; 26:295–302[Medline]

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