Multinational European project and multicenter Spanish study of quality improvement of assistance on consultation-liaison psychiatry in general hospital: clinical profile in Spain

BACKGROUND: In the frame of the European study on quality assurance in cons ultation liaison psychiatry and psychosomatics (supported by the BIOMED 1 p rogram), the clinical "process" of consultation-liaison psychiatry units pe rtaining to six Spanish general hospitals is analyzed. PATIENTS AND METHOD: A sample of 3.608 consecutive patients referred to the consultation-liaison psychiatry units of five public general hospitals (Cl inico of Zaragoza, Clinico of Barcelona, General of Alicante, Ramon y Cajal of Madrid, Princesa of Madrid) and one private gynecological hospital (Dex eus of Barcelona) was studied. The data were recorded with a standardized i nstrument (CL-BDoK-P), validated in a previous study. RESULTS: consult request took place 10.6 days (on average) after the patien ts admission ("lagtime 1"), half the requests were urgent, and psychiatric consultants examined the patients 1.9 days (on average) after the request(" lagtime 2"). The most frequent reasons for referral were current psychiatri c symptoms (50.3%), unexplained physical symptoms (15.2%), substance abuse (9.2%), psychiatric history (8.5%), suicide risk (6%) and coping with illne ss (5.8%). The main referral services were internal medicine (17.5%), traum atology (7.5%) and general surgery (7.3%). An important clinical activity i s documented in patients frequently considered to be "complex", with broad spectrum diagnostic and interventions processes and both in-hospital and ou t-patient follow-up. However, some problems were also detected in the clini cal "process". CONCLUSIONS: The results outline the clinical importance of Spanish consult ation-liaison psychiatry in the general hospital, but the possibility of im proving its efficiency through the implementation of integrative models, or ganizational changes and modern models of "quality assurance" is also empha sized.