Reference to psychiatric consultation in the discharge letter of general hospital inpatients

Objective: The consultation-liaison psychiatrist is frequently confronted with the consultees' lack of adherence to the consultants' recommendations. The aim of this study was to investigate the question if and how the C-L psychiatrist's diagnoses and recommendations are mentioned in the consultee's final medical report and thus communicated to the physician responsible for the aftercare. Method: Psychiatric consult reports of a consecutive sample of 144 patients of the departments of neurology, internal medicine, and gynecology and obstetrics at the University Hospital of Zurich were compared to the content of the respective discharge letters. Results: Some kind of information about the psychiatric consultation was found in 84 percent of the discharge letters (consultation as such: 71.5%; psychiatric diagnosis: 6.7%; recommendations: 76.2%). Length of stay, timing of the consultation, length of the consult report and type of recommendation correlated significantly with the mention of psychiatric aspects in the final medical report. Psychotropic medication and psychiatric hospitalization were the recommendations most reliably mentioned. Conclusions: Psychiatric consultation seems to be taken seriously by attending physicians and is communicated in a high percentage to the physicians responsible for the aftercare. Nevertheless, in patients where active post-discharge management is needed the C-L psychiatrist should actively manage referral to outpatient settings and/or instruct primary care providers.