Measuring Quality Standards for a Consultation-Liaison Psychiatry Service in a Chilean Teaching Hospital

ABSTRACT

Background: To date, scarce structured guidelines for the assessment of service quality improvement interventions and service quality standards for Consultation Liaison Psychiatry Services (CLP) have been described (1-4). Our aim is to measure the impact of introducing an electronic triage referral system (ETR) and a proactive CLP model (PCL) during the COVID-19 pandemic by establishing key performance indicators (KPI). Methods: Observational exploratory study conducted at the Hospital Clínico Red Salud-UCChristus, a teaching hospital in Santiago, Chile, ∼400 beds. ETR was introduced in May 2020, and PCLP from May to August 2020. Data was collected from CLP discharged records, from January 2019 to September 2021. Study approved by our Ethical Review Board. Results: We observed a constant increase in the number of referrals and assessments from 2019 to 2021. Most frequent referrals in 2019-2021 were made by the Internal Medicine team and the most common diagnosis was delirium. Two main KPIs were assessed • Time of Response (ToR) After the introduction of ETR, there was an increase in the % of patients seen within 24 hours of referral between 2019, 2020 & 2021 (51.4%, 69.9% and 71.3% respectively). A similar trend was observed in ToR within 48 hours. Of those considered urgent by referrers, 87% were seen within 24 hours of referral in both 2020 and 2021, with an overall achievement of 100% within 48 hours. • “Staffing workload index” (SWI) After ETR & PCL were introduced, we observed an increase in staffing available working hours at the hospital in 2020 and 2021 (40% increase), which was sustained after PCL was terminated. We were able to estimate a rate between staff hours and average referrals per week (SWI), to measure the staff turn towards clinical activities as needed by referrals. The overall SWI was 1.32 in 2019, 1.57 in 2020 (1.05 during 3-month COVID-19 peak of cases) and 1.09 in 2021. Moreover, SWI had a -0.17 correlation with % of ToR Discussion: The ETR and PCL initiatives had an impact in our service, as observed in our KPIs ToR and SWI. Our CLP service has been able to adapt to service demands, by increasing staffing available working hours when needed and reducing time of response. Conclusions: ToR may be a useful and easy to collect KPI to routinely monitor service efficiency. Still remains a challenge for our service to introduce qualitative parameters of service user satisfaction in a 360º fashion to integrate patients, family, referrers and CLP staff. Trials to assess the efficacy of introducing complex interventions such as ETR, PCL and KPI surveillance are needed. References 1. Trigwell, P., & Kustow, J. (2016). A multidimensional Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP). BJPsych bulletin, 40(4), 192–194. https//doi.org/10.1192/pb.bp.115.051458 2. Wood, R., & Wand, A. P. (2014). The effectiveness of consultation-liaison psychiatry in the general hospital setting: a systematic review. Journal of psychosomatic research, 76(3), 175–192.https//doi.org/10.1016/j.jpsychores.2014.01.002 3. Brightey-Gibbons F, Patterson E, Rhodes E, Ryley A, Hodge S, Eds. Quality Standards for Liaison Psychiatry Services (Fifth ed.). London Royal College of Psychiatrists;2017. 4. Kovacs, Z., Asztalos, M., Grøntved, S., & Nielsen, R. E. (2021). Quality assessment of a consultation-liaison psychiatry service. BMC psychiatry, 21(1), 281. https//doi.org/10.1186/s12888-021-03281-4