(PO-185) Clinical and Sociodemographic Characteristics of Patients admitted to a Specialized Medical-Psychiatric Unit in an Academic Tertiary Care Hospital: A 6-month Analysis
Background: Medical-Psychiatric Units (MPUs), alternatively referred to as “medical psychiatry units” and “joint care units,” are inpatient settings capable of integrating both medical and behavioral health issues with a specialized team of clinicians. Although MPUs have been were more popularly described in the literature in past decades (Fava et al, 1980; Kathol, 1194), they have gained increased attention in recent years in the context of value-based medicine (Chan et al, 2018). Consultation-liaison psychiatrists are uniquely equipped to either function in or manage such settings, and benefit from understanding of clinical and sociodemographic characteristics of an academically-based MPU as reported here.
Methods: A retrospective electronic medical record review of the past 6 months of admissions to a specific MPU at a large academic tertiary care hospital was performed. The unit is a medical inpatient floor with 25 beds, behaviorally-trained nurses/social workers, specialized social workers and case managers for complex disposition planning, rotating embedded CL psychiatrists, and enhanced supervision rooms for patient monitoring. Clinical and sociodemographic variables were collected and analyzed for trends. Descriptive statistics were used.
Results: 468 total admissions over a 6-month period ranging from October 1 2020 to March 31 2021 were reviewed. Abbreviated and select findings are reported here. Ages ranged from 18 to 105; most were age 65 or older (n=332, 71%). 296 were female (63%). The most common neuropsychiatric diagnostic categories listed by the admitting medical service included “altered mental status”/encephalopathy with or without dementia (n= 141, 30%). Failure to thrive/weakness (n=38, 8%) and falls/syncope were also common (n=33, 7%). Full examination of the data with expanded clinical and cost parameters are available for review and discussion.
Discussion: This specific MPU specializes in geriatric populations with significant psychiatric comorbidity, neurocognitive and functional decline, and extended hospitalizations. These findings are limited by the retrospective nature of the search and inherent limitations posed by the electronic medical record (e.g., failure to capture overlapping diagnoses). Future analyses would benefit from a control sample to investigate differences across populations and better understand the direct impact of the MPU on certain clinical and cost parameters.
Conclusion/Implications: CL psychiatrists stand to benefit from greater awareness of MPUs and the clinical and sociodemographic characteristics of patients admitted to them. CL psychiatrists can add tremendous value to health systems by either operating in or managing MPUs. The literature on MPUs is reviewed, as well as future potential directions.
Fava GA, Wise TN, Molnar G, et al. The medical-psychiatric unit: A novel psychosomatic approach. Psychother Psychosom. 1985;43(4):194-201.
Kathol RG. Medical psychiatry units: the wave of the future. Gen Hosp Psychiatry. 1994;16(1):1-3.
Chan AC, Burke CA, Coffey EM, et al. Integrated Inpatient Medical and Psychiatric Care: Experiences of 5 Institutions. Annals of Internal Medicine. 2018;168(11):815-18.
Appreciate clinical and sociodemographic trends in a specialized medical-psychiatric unit.
Acknowledge the benefits of a medical-psychiatric unit in terms of integrated care, concentrated expertise, cost reduction, and improved outcomes.