Psych CL Shortens Hospital Stays

Background

Psychiatric disorders affect 20–40% of hospitalized patients, and untreated symptoms slow recovery, complicate adherence, and drive-up costs. Consultation-liaison psychiatry brings psychiatric expertise into general medical and surgical settings, and earlier involvement has consistently been linked to shorter stays.

The Study

• Retrospective cohort study of 2,070 adults referred to consultation-liaison psychiatry in France.
• Most were middle-aged (mean age 53), slightly more than half were men, and the majority had stress-related or mood disorders.
• Examined how the timing of the psychiatric consultation related to total length of stay, controlling for age, sex, diagnosis, ward type, and year of admission.

Results

Median length of stay was 4 days when psychiatry was consulted within 2 days of admission, rising to 7 days for days 3–5, 13 days for days 6–10, and 35 days when consultation was delayed beyond 10 days. This relationship held after adjusting for all covariates.

Two ward types stood out for late referrals: surgical units and intensive care units. Consultations in these settings came significantly later, possibly because psychiatric symptoms get deprioritized when patients are sedated or acutely ill. Interestingly, referrals were actually faster during 2020 and 2021 — the COVID pandemic years — likely reflecting a surge in stress-related presentations and a corresponding shift in priorities.

Limitations: Retrospective observational study, and causality can’t be established. Sicker patients may have longer stays for reasons unrelated to psychiatric care. Severity of medical illness, prior psychiatric history, and COVID-19 status weren’t captured, and the authors only included patients who received a consultation, so comparisons to no consultation aren’t possible.

Practice Implications

1. The data replicate earlier findings from a different French hospital and add a COVID-era sample.
2. If you’re receiving consults, ask to be looped in earlier, and share the data with administrators.