REFERENCE TO PSYCHIATRIC-CONSULTATION IN THE DISCHARGE LETTER OF GENERAL-HOSPITAL INPATIENTS

Objective: The consultation-liaison psychiatrist is frequently confron ted with the consultees' lack of adherence to the consultants' recomme ndations. The aim of this study was to investigate the question if and how the C-L psychiatrist's diagnoses and recommendations are mentione d in the consultee's final medical report and thus communicated to the physician responsible for the aftercare. Method: Psychiatric consult reports of a consecutive sample of 144 patients of the departments of neurology, internal medicine, and gynecology and obstetrics at the Uni versity Hospital of Zurich were compared to the content of the respect ive discharge letters. Results: Some kind of information about the psy chiatric consultation was found in 84 percent of the discharge letters (consultation as such: 71.5%; psychiatric diagnosis: 6.7%; recommenda tions: 76.2%). Length of stay, timing of the consultation, length of t he consult report and type of recommendation correlated significantly with the mention of psychiatric aspects in the final medical report. P sychotropic medication and psychiatric hospitalization were the recomm endations most reliably mentioned. Conclusions: Psychiatric consultati on seems to be taken seriously by attending physicians and is communic ated in a high percentage to the physicians responsible for the afterc are. Nevertheless, in patients where active post-discharge management is needed the C-L psychiatrist should actively manage referral to outp atient settings and/or instruct primary care providers.