Bibliographical noteFunding Information:
Acknowledgments: The authors were supported in part for the Medical Psychiatry Program at HCMC via a grant from UCare.
Implementation of these solutions required leaders willing to work outside their “silos,” add teaching time to their schedules, and share control of resources. Given HCMC’s financial support for the APPs (in part covered by patient charges), the program has been sustainable. Our Tuesday morning rounds have catalyzed a process of workforce development. Nurses, doctors, and pharmacists have begun to view patients differently, and we anticipate attendees will advance their training in new directions. We are not finished with improving medical coverage for the psychiatry wards. Currently, there are approximately eight APPs covering days and nights along with psychiatry residents; hospitalists “check in” with the APPs in the mornings, staff a 24/7 medical consult service, and often cross cover for admission H and P’s at night. By June of 2013 we plan to initiate expanded hospitalist coverage 52 weeks a year, providing direct and supervisory care with the APPs on the wards.
A Medical Psychiatry oversight group began meeting monthly to address program development. We were fortunate to receive strong financial support from the hospital (HCMC) at many critical junctures. The business case was straightforward. We argued that comprehensive care of patients with coexisting medical and psychiatric illness would sharply diminish transfers, rapid response calls, readmissions, length of stay, and adverse events. With that guiding framework, we built medical programs in the psychiatric inpatient unit, brought internists to practice in the Day Treatment program, embedded mental health professionals in Medicine Clinic, and have been planning for an eight-bed Med-Psych unit on the Medicine Service (Table 1). The underlying premise has been that a patient with medical and psychiatric illness is “one person,” and that this person needs comprehensive care at his or her primary site of care.
- behavioral medicine
- medical psychiatry