Research project question. Input appreciated from all

[Unico]

Hello SND Psychiatry! Hope everyone is well.

I am working on a research project that aims at combining neurology rounds and C&L consult service on the floors at my training hospital.

Curious if anyone is in a program, or is a PD/attending, that currently has a C&L service which has an attending from both Psychiatry and Neurology during rounds?

The neurology attending at our hospital wants to round with the C&L team for patients that have a psychiatry consult and a neurology consult. For example, the ICU patient with delirium where the primary team has placed consults with both neurology and psychiatry.

Do any of you have experience with this type of setup? Does anyone have combined rounds with a multidisciplinary team for C&L?

Thanks in advance!

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[Sushirolls]

Sounds painful and like it could be a waste of resources. I suspect the time spent rounding together will waste more time, and coordinating those rounds to start together, then the potential time saving benefits it might possibly provide by have both services face to face.

In the case of an ICU delirium, it would be worthwhile for both Neuro and Psych to call the ICU service and clarify what their consult question is. Once they have some idea of what they want, then go do the consult.

 

[lyla]

This sounds like it has a potential for shotgunning both neuro and psych with the consultees thinking “yes somehow someone from either neuro or psych will figure this out for us”... instead of them actually articulating their question clearly.

 

[whopper]

St. Louis U used to have a combined psych and neurology department but despite this there really wasn't an interface between both departments that seemed to merit the two be under the same roof. Yeah we had department meetings together (while I was there), yes we had the same department head but it's not like the neurologists and I were working in a manner that made a difference had the departments been separate at other places I've worked.

If anything it caused A LOT of problems for the people running the department. There was a lot of drama going on where whenever the head of the department became so he'd get flack from the field outside his own specialty. e.g if the head was a psychiatrist, neuro would give him flack, and vice versa if the head was a neurologist.

While of course any physician should work in a cordial and cooperative manner with other physicians (and we all know this doesn't happen all the time, or even close to it) being all in the same department didn't somehow take away the disruptive factor from typically uncooperative physicians. Hey if the guy's a narcissist it doesn't matter if you're under the same roof. He's still a narcissist. I can tell you plenty of times working with people in the same department would fill me with frustration. It's not like now that his office is right next to mine vs a 4 minute walk away did it somehow make a major change.

I've also noticed that better physicians will not box themselves into a corner in trying to understand what's only in their specialty. Again having a combined department I didn't notice it making doctors that were closed minded to the bigger picture open their eyes.

 

[downwithDTB]

This seems like a solution proposed without enough of a question.

Why are both neuro and psych being consulted on cases? How often does this occur? What percentage of the work flow of each service is co-consult? What are the actual inefficiencies in the current system whereby something is being lost?

There may be some redundancy in the system whereby neuro and psych are essentially being asked to do the same work on the same patients that either specialty can handle. This may be better solved with education of consulters and better turf agreements.

There may be bad consults (I think this is neuro or psych so I'll consult them), which requires education and limit setting.

The two services might consult on the same patients a lot but because one rounds in the morning and the other in the afternoon, the recs aren't beginning coordinated efficiently and the nurses are mad about low DBN rates.

Or perhaps there are a lot of complicated patients who require high level psych and neuro discussions and co-rounding would be really efficient.

In sum: first identify the problem, then identify a metric to determine if the problem was solved and then propose an intervention, test it, and see if your intervention worked.

 

[Coupd'Cat]

If you haven't already, it might be worthwhile to interview stakeholders such as residents receiving the consults, primary teams, etc. to get at the questions posed by @downwithDTB and unearth issues you wouldn't have imagined before having those conversations. I also might look into any literature backing up the purpose of more common existing interdisciplinary boards (tumor boards, liver boards). This would all be dictated by the specific problem and need you identify (efficiency? discussion of complex cases?), since this would determine the type of intervention needed.