Abstract：
BACKGROUND: Proactive psychiatric consultation services rapidly identify and assess medical inpatients in need of psychiatric care. In addition to more rapid contact, proactive services may reduce the length of stay and improve staff satisfaction. However, in some settings, it is impractical to integrate a proactive consultation service into every hospital unit; on-request and proactive services are likely to coexist in the future. Prior research has focused on changes in outcomes with the implementation of proactive services.
OBJECTIVE: This report describes differences between contemporary proactive and on-request services within the same academic medical center, comparing demographic and clinical data collected retrospectively from a 4-year period from the electronic medical record.
RESULTS: The proactive service saw patients over four times as many initial admissions (7592 vs. 1762), but transitions and handoffs between services were common, with 434 admissions involving both services, comprising nearly 20% of the on-request service\'s total contacts. The proactive service admissions had a shorter length of stay and a faster time to first psychiatric contact, and the patients seen were more likely to be female, of Black race, and to be publicly insured. There were over three times as many admissions to psychiatry from the proactive service. The on-request service\'s admissions had a longer length of stay, were much more likely to involve intensive care unit services, surgical services, and transfers among units, and the patients seen were more likely to die in the hospital or to be discharged to subacute rehabilitation.
CONCLUSIONS: Overall, the results suggest that the two services fulfill complementary roles, with the proactive service\'s rapid screening and contact providing care to a high volume of patients who might otherwise be unidentified and underserved. Simultaneously, the on-request service\'s ability to manage patients in response to consult requests over a much larger area of the hospital provided important support and continuity for patients with complex health needs. Institutions revising their consultation services will likely need to consider the best balance of these differing functions to address perceived demand for services.
OBJECTIVE: This report describes differences between contemporary proactive and on-request services within the same academic medical center, comparing demographic and clinical data collected retrospectively from a 4-year period from the electronic medical record.
RESULTS: The proactive service saw patients over four times as many initial admissions (7592 vs. 1762), but transitions and handoffs between services were common, with 434 admissions involving both services, comprising nearly 20% of the on-request service\'s total contacts. The proactive service admissions had a shorter length of stay and a faster time to first psychiatric contact, and the patients seen were more likely to be female, of Black race, and to be publicly insured. There were over three times as many admissions to psychiatry from the proactive service. The on-request service\'s admissions had a longer length of stay, were much more likely to involve intensive care unit services, surgical services, and transfers among units, and the patients seen were more likely to die in the hospital or to be discharged to subacute rehabilitation.
CONCLUSIONS: Overall, the results suggest that the two services fulfill complementary roles, with the proactive service\'s rapid screening and contact providing care to a high volume of patients who might otherwise be unidentified and underserved. Simultaneously, the on-request service\'s ability to manage patients in response to consult requests over a much larger area of the hospital provided important support and continuity for patients with complex health needs. Institutions revising their consultation services will likely need to consider the best balance of these differing functions to address perceived demand for services.
摘要：
背景：积极的精神病咨询服务可快速识别和评估需要精神病治疗的住院患者。除了更快速的接触，积极主动的服务可能会减少逗留时间并提高员工满意度。然而,在某些设置中，将主动咨询服务整合到每个医院单位是不切实际的；应请求服务和主动服务将来可能共存。先前的研究集中在实施主动服务后结果的变化。
目的：本报告描述了同一学术医疗中心内当代主动服务和按要求服务之间的差异，比较4年期间从电子病历中回顾性收集的人口统计学和临床数据.
结果：主动服务的患者数量是初次入院的四倍多（7592对1762),但是服务之间的转换和切换很常见，涉及这两项服务的招生人数为434人，占按请求服务总联系人的近20%。主动服务入院的住院时间较短，首次精神病接触的时间也较快，看到的患者更有可能是女性，黑人种族，并向公众投保。从主动服务中接受精神病学的人数是其三倍以上。应要求服务的入场时间更长，更有可能涉及重症监护室服务，外科服务,和单位之间的转移，看到的患者更有可能在医院死亡或出院接受亚急性康复治疗。
结论：总体而言，结果表明，这两种服务履行了互补的角色，通过主动服务的快速筛查和联系，为大量可能身份不明和服务不足的患者提供护理。同时,应请求服务能够响应医院更大范围内的咨询请求来管理患者，为有复杂健康需求的患者提供了重要的支持和连续性。修改咨询服务的机构可能需要考虑这些不同职能的最佳平衡，以满足对服务的感知需求。
目的：本报告描述了同一学术医疗中心内当代主动服务和按要求服务之间的差异，比较4年期间从电子病历中回顾性收集的人口统计学和临床数据.
结果：主动服务的患者数量是初次入院的四倍多（7592对1762),但是服务之间的转换和切换很常见，涉及这两项服务的招生人数为434人，占按请求服务总联系人的近20%。主动服务入院的住院时间较短，首次精神病接触的时间也较快，看到的患者更有可能是女性，黑人种族，并向公众投保。从主动服务中接受精神病学的人数是其三倍以上。应要求服务的入场时间更长，更有可能涉及重症监护室服务，外科服务,和单位之间的转移，看到的患者更有可能在医院死亡或出院接受亚急性康复治疗。
结论：总体而言，结果表明，这两种服务履行了互补的角色，通过主动服务的快速筛查和联系，为大量可能身份不明和服务不足的患者提供护理。同时,应请求服务能够响应医院更大范围内的咨询请求来管理患者，为有复杂健康需求的患者提供了重要的支持和连续性。修改咨询服务的机构可能需要考虑这些不同职能的最佳平衡，以满足对服务的感知需求。
