U. Schnyder et al., REFERENCE TO PSYCHIATRIC-CONSULTATION IN THE DISCHARGE LETTER OF GENERAL-HOSPITAL INPATIENTS, International journal of psychiatry in medicine, 27(4), 1997, pp. 391-402
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.