Hospitalists Caring for Behavioral Health Inpatients: A Hybrid Consultation Model.

Abstract

There is no established best practice for optimal medical consultant care to address the medical needs of psychiatric inpatients at a behavioral health center (BHC). To evaluate the feasibility and acceptability of a hybrid on-site and virtual model of internal medicine consultative care in a BHC. To provide continuous medical consultation availability for 233 patients in a BHC, 9 internal medicine hospitalists from the affiliated academic medical center joined 1 full-time internist and 21 medical nurse practitioners, supporting 34 psychiatry providers. Hospitalists performed medical evaluation prior to electroconvulsive and ketamine therapies, hybrid on-site and remote consultation for acute concerns, test results, medication effects, and chronic diseases, electrocardiogram review, and pre-admission assessments. BHC faculty were anonymously surveyed. 8/8 hospitalists and 11/34 psychiatrists responded. Qualitative data were coded and thematically analyzed. Psychiatrists appreciated hospitalists' expertise, communication, and collaborative problem-solving. Hospitalists found meaning in developing new clinical expertise and caring for vulnerable patients. Hospitalists credited the hybrid role with enhancing work-life integration. Challenges included handoffs, delineation of responsibilities, and virtual work impacting team cohesion. A hybrid consultation model allows hospitalists and psychiatrists to collaboratively care for BHC inpatients with professionally and personally rewarding work.