Lawrence Memorial Hospital - Psychiatric Consultation Team & Crisis Stabilization Service

What is it?

The Psychiatric Consultation Team consists of an experienced psychiatric nurse and an on-call psychiatrist. At the request of nurses, physicians and social work staff, the team provides psychiatric assessment and care for patients admitted with medical conditions on all nursing units, cardiac rehab, oncology, and outpatient services. If it is determined patients need inpatient or outpatient psychiatric services after discharge for their medical diagnoses, the team can assist with appropriate placement and referrals. The team has also been instrumental in serving in a teaching role to other staff regarding mental health issues.

The Psychiatric Crisis Stabilization Service supports mental health services in the emergency department (ED) and enhances the care and safety of all emergency patients. Two rooms were specially designed to provide a safe, quiet space, somewhat removed from the medical beds in the ED. This area is staffed by nurses who provide one-on-one attention to patients. Patients may stay as long as necessary while their psychiatric needs are assessed, care administered, and discharge planning implemented. Social work staff provides psychiatric assessment and assists the emergency physician with care and planning.

Who is it for?

Patients who come to the ED requiring psychiatric assessment and emergent care; patients who are admitted to Lawrence Memorial Hospital for a medical reason but who also need some attention to a psychiatric condition.

Why do they do it?

Since 1973, Lawrence Memorial Hospital (LMH) had a 15-bed inpatient Mental Health Unit that served adult and geriatric psychiatric patients. In 2003, a series of events severely affected the unit. In a period of three months, three psychiatrists and a nurse practitioner providing inpatient coverage resigned from active status – two for relocation, one for health reasons, and one due to his increased outpatient load. With only two psychiatrists left to admit and treat inpatients and perform on-call duties, the unit was closed to adult crisis patients in September 2003. Geriatric patients continued to be admitted. In March 2004 a fourth psychiatrist retired from active status. Despite exhaustive efforts to maintain a quality program, LMH was forced by the lack of physician coverage and low patient volumes to close the unit in April 2004. The national trend away from inpatient psychiatric treatment had negatively impacted the service to the point that it was no longer feasible – in terms of quality, programming, staffing, volumes and finances – to continue to successfully operate.

LMH Administration and the Board of Trustees knew that people with psychiatric concerns would still be admitted for other medical conditions, and that their mental health needs could not be ignored. In addition, the LMH ED will always provide a safety net for psychiatric crisis management. The development of the Psychiatric Consultation Team and the addition of the Psychiatric Crisis Stabilization Service have proved to be innovative and resourceful ways to provide for the mental health needs of patients in our community hospital.

Impact

The Psychiatric Consultation Team served 174 patients in 2006 at a loss of approximately $155,000. The Psychiatric Crisis Stabilization Service has been very successful in helping psychiatric patients who are in crisis, ensures privacy and safety, and improves capacity to treat all ED patients. Emergency visits in 2006 numbered 31,606 with 552 patients being seen in the Psychiatric Crisis Stabilization Service.

Contact: Janice Early
Director of Community Relations
Telephone: 785-840-3132
E-mail: janice.early@lmh.org