Assessing Attitudes and Practices Regarding Referral to Outpatient Psychiatric Follow-up After Inpatient Consultation

Background: Referral to outpatient mental health care is a core service of inpatient consultation-liaison (C-L) psychiatry but remains underexplored in the literature. Studies suggest poor adherence to recommended outpatient psychiatric care after inpatient consultation, with outpatient follow-up rates ranging from 20-57% (Weddington, 1983; Ehrenreich, 2012). The aim of this project was to assess the attitudes and practices of clinicians at our institution’s acute medical hospitals who regularly make outpatient psychiatric referrals in order to identify opportunities to improve linkage to outpatient care.

Methods: Using a mixed-methods analysis, we first conducted semi-structured interviews with 4 members of our C-L team and 5 social workers on inpatient medical units to map current outpatient psychiatric referral processes and identify areas to explore further. We used information gathered from these interviews to create an electronic survey for members of our C-L team across nine medical hospitals and social workers at our institution’s flagship medical hospital. Survey data was analyzed using descriptive statistics. This project was approved by our institution’s Quality Improvement Review Committee and deemed not to require Institutional Review Board oversight.

Results: 44 participants completed the survey, with a 30% response rate. 61% of participants strongly agreed or agreed that providing outpatient referrals was an important part of their current role. Participants were more likely to rate themselves as very comfortable or somewhat comfortable making outpatient referrals for patients with anxiety disorders (88%) and mood disorders (83%) compared to patients with eating disorders (58%) and neurocognitive disorders (52%) and patients from rural areas (35%). Most participants rated themselves very likely or somewhat likely to discuss the referral with the patient (95%) and add referral information to the discharge summary (65%). Only 44% of respondents were very likely or somewhat likely to contact outpatient providers to schedule a follow-up appointment prior to discharge.

Discussion & Conclusion: To our knowledge, this is the first published assessment of a C-L service’s attitudes and practices regarding referral to outpatient mental health follow-up. Our survey identified variability in clinicians’ comfort referring certain patient populations to outpatient care. This data suggests potential targeted interventions to improve outpatient follow-up rates, for example informing C-L clinicians about telehealth options for patients from rural areas. We also found variation in clinicians’ referral processes which suggests an opportunity to create standardized referral pathways and to identify and disseminate best practices.

References:
1. Weddington WW: Adherence by medical-surgical inpatients to recommendations for outpatient psychiatric treatment. Psychotherapy and Psychosomatics 1983; 39(4): 225–35.
2. Ehrenreich M, Robinson C, Glovinsky D, Dixon L, Medoff D, Himelhoch S: Medical inpatients’ adherence to outpatient psychiatric aftercare: A prospective study of patients evaluated by an inpatient consultation liaison psychiatry service. International Journal of Psychiatry in Medicine 2012; 44(1): 1–15.