Integrated Inpatient Medical and Psychiatric Care: Experiences of 5 Institutions

Abstract

Ideas and Opinions5 June 2018Integrated Inpatient Medical and Psychiatric Care: Experiences of 5 InstitutionsAubrey C. Chan, MD, PhD, Christopher A. Burke, MD, Ellen M. Coffey, MD, David R. Hilden, MD, MPH, Diego L. Coira, MD, Jessy Warner-Cohen, PhD, MPH, Margaret Grady, MSN, APN-C, Philip R. Muskin, MD, MA, and Gen Shinozaki, MDAubrey C. Chan, MD, PhDUniversity of Iowa Hospitals and Clinics, Iowa City, Iowa (A.C.C., G.S.), Christopher A. Burke, MDLong Island Jewish Medical Center, New Hyde Park, New York (C.A.B., J.W.), Ellen M. Coffey, MDHennepin County Medical Center, Minneapolis, Minnesota (E.M.C., D.R.H.), David R. Hilden, MD, MPHHennepin County Medical Center, Minneapolis, Minnesota (E.M.C., D.R.H.), Diego L. Coira, MDCoira Institute, Franklin Lakes, New Jersey (D.L.C., M.G.), Jessy Warner-Cohen, PhD, MPHLong Island Jewish Medical Center, New Hyde Park, New York (C.A.B., J.W.), Margaret Grady, MSN, APN-CCoira Institute, Franklin Lakes, New Jersey (D.L.C., M.G.), Philip R. Muskin, MD, MAColumbia University Medical Center, New York, New York (P.R.M.), and Gen Shinozaki, MDUniversity of Iowa Hospitals and Clinics, Iowa City, Iowa (A.C.C., G.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-3186 Annals Author Insight Video - Gen Shinozaki, MD In this video, Gen Shinozaki, MD, offers additional insight into the article, "Integrated Inpatient Medical and Psychiatric Care: Experiences of 5 Institutions." SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Many patients hospitalized with acute medical illness have comorbid psychiatric or substance use disorders. The estimated prevalence of psychiatric conditions in medical inpatients is 10% to 40% (1, 2). The presence of a comorbid psychiatric or substance use disorder negatively affects outcomes, such as mortality, length of stay (LOS), cost of care, and readmission rate (2). Persons with delirium and geriatric patients with cognitive disorders often exhibit behavioral disturbances, such as removing medical devices and wandering, leading to sentinel events, such as falls or violence toward other patients or health care staff. Conversely, persons with chronic mental illness have a ...References1. Hussain M, Seitz D. Integrated models of care for medical inpatients with psychiatric disorders: a systematic review. Psychosomatics. 2014;55:315-25. [PMID: 24735866] doi:10.1016/j.psym.2013.08.003 CrossrefMedlineGoogle Scholar2. Owens P, Myers M, Elixhauser A, Brach C. Healthcare Cost and Utilization Project Fact Book no. 10. Bethesda: Agency for Healthcare Research and Quality; 2007. Google Scholar3. Baumeister H, Haschke A, Munzinger M, Hutter N, Tully PJ. Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review. Biopsychosoc Med. 2015;9:11. [PMID: 25969694] doi:10.1186/s13030-015-0039-z CrossrefMedlineGoogle Scholar4. Briskman I, Bar G, Boaz M, Shargorodsky M. Impact of co-morbid mental illness on the diagnosis and management of patients hospitalized for medical conditions in a general hospital. Int J Psychiatry Med. 2012;43:339-48. [PMID: 23094466] CrossrefMedlineGoogle Scholar5. Mather B, Roche M, Duffield C. Disparities in treatment of people with mental disorder in non-psychiatric hospitals: a review of the literature. Arch Psychiatr Nurs. 2014;28:80-6. [PMID: 24673780] doi:10.1016/j.apnu.2013.10.009 CrossrefMedlineGoogle Scholar6. Kathol RG, Kunkel EJ, Weiner JS, McCarron RM, Worley LL, Yates WR, et al. Psychiatrists for medically complex patients: bringing value at the physical health and mental health/substance-use disorder interface. Psychosomatics. 2009;50:93-107. [PMID: 19377017] doi:10.1176/appi.psy.50.2.93 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Iowa Hospitals and Clinics, Iowa City, Iowa (A.C.C., G.S.)Long Island Jewish Medical Center, New Hyde Park, New York (C.A.B., J.W.)Hennepin County Medical Center, Minneapolis, Minnesota (E.M.C., D.R.H.)Coira Institute, Franklin Lakes, New Jersey (D.L.C., M.G.)Columbia University Medical Center, New York, New York (P.R.M.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3186.Corresponding Author: Gen Shinozaki, MD, University of Iowa Hospitals and Clinics, Department of Psychiatry, Medical Laboratories B002F, 25 South Grand Avenue, Iowa City, IA 52242; e-mail, [email protected]edu.Current Author Addresses: Dr. Chan: University of Iowa Hospitals and Clinics, Department of Psychiatry and Internal Medicine, 200 Hawkins Drive, Iowa City, IA 52242.Dr. Burke: Long Island Jewish Medical Center, 270-05 76th Avenue, Staff House Room 306, New Hyde Park, NY 11040.Dr. Coffey: Hennepin County Medical Center, Department of Internal Medicine, 701 Park Avenue, Minneapolis, MN 55415.Dr. Hilden: Hennepin County Medical Center, Department of Medicine G5, 701 Park Avenue, Minneapolis, MN 55415.Dr. Coira and Ms. Grady: Coira Institute, 851 Franklin Lake Road, Suite 105, Franklin Lakes, NJ 07417.Dr. Warner-Cohen: Long Island Jewish Medical Center, Department of Psychiatry, 270-05 76th Avenue, New Hyde Park, NY 11040.Dr. Muskin: Columbia University Medical Center, Department of Psychiatry, 622 West 168th Street, Mailbox #427, New York, NY 10032.Dr. Shinozaki: University of Iowa Hospitals and Clinics, Department of Psychiatry, Medical Laboratories B002F, 25 South Grand Avenue, Iowa City, IA 52242.Author Contributions: Conception and design: A.C. Chan, C. Burke, E. Coffey, D.R. Hilden, D.L. Coira, J. Warner-Cohen, M. Grady, G. Shinozaki.Analysis and interpretation of the data: A.C. Chan, C. Burke, D.L. Coira, J. Warner-Cohen, M. Grady, G. Shinozaki.Drafting of the article: A.C. Chan, C. Burke, E. Coffey, D.L. Coira, P.R. Muskin, G. Shinozaki.Critical revision for important intellectual content: A.C. Chan, C. Burke, D.R. Hilden, D.L. Coira, P.R. Muskin, G. Shinozaki.Final approval of the article: A.C. Chan, C. Burke, E. Coffey, D.R. Hilden, D.L. Coira, J. Warner-Cohen, M. Grady, P.R. Muskin, G. Shinozaki.Provision of study materials or patients: C. Burke, D.R. Hilden, J. Warner-Cohen.Administrative, technical, or logistic support: M. Grady, G. Shinozaki.Collection and assembly of data: C. Burke, E. Coffey, D.R. Hilden, D.L. Coira, J. Warner-Cohen, M. Grady, P.R. Muskin, G. Shinozaki.This article was published at Annals.org on 24 April 2018. PreviousarticleNextarticle Advertisement Annals Author Insight Video - Gen Shinozaki, MD In this video, Gen Shinozaki, MD, offers additional insight into the article, "Integrated Inpatient Medical and Psychiatric Care: Experiences of 5 Institutions." FiguresReferencesRelatedDetails Metrics Cited byMoving Beyond the Status Quo of Integrated Inpatient Medical and Psychiatric Care Units: The Path to Real-World EvaluationOrganization and Outcomes of Integrated Inpatient Medical and Psychiatric Care Units: A Systematic ReviewObservational cohort study of the triggers, diagnoses and outcomes of the medical emergency team (MET) response in adult psychiatry inpatients colocated with acute medical services in AustraliaProactive Integrated Consultation-Liaison Psychiatry: A new service model for the psychiatric care of general hospital inpatientsTaking the Long View in an Inpatient Medical Unit: A Person-Centered, Integrated Team Approach for Patients With Severe Mental IllnessesMeasuring outcomes on a Medical Psychiatric Unit: HoNOS,, CANSAS and costsTowards integrated medical and mental healthcare in the inpatient setting: what is the role of psychology? 5 June 2018Volume 168, Issue 11Page: 815-817KeywordsDiagnosis related groupsDisclosureInpatientsLength of stayMortalityOutpatientsPatientsSuicideTriageType 1 diabetes ePublished: 24 April 2018 Issue Published: 5 June 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. 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