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Am J Psychiatry 1991; 148:1044-1049
Copyright © 1991 by American Psychiatric Association
Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients
JJ Strain, JS Lyons, JS Hammer, M Fahs, A Lebovits, PL Paddison, S Snyder, E Strauss, R Burton and G Nuber
Mount Sinai Medical Center, Department of Psychiatry and Behavioral Sciences, New York, NY 10029-6574.
OBJECTIVE: The authors hypothesized that psychiatric liaison screening of
elderly patients with hip fractures would shorten the average length of
hospital stay and increase the proportion of patients who returned home
after discharge. METHOD: The study was performed at Mount Sinai Medical
Center in New York and Northwestern Memorial Hospital in Chicago. The
subjects were 452 patients 65 years or older who were consecutively
admitted for surgical repair of fractured hips. During a baseline year the
patients received traditional referral for psychiatric consultation. During
the experimental year all the patients at Mount Sinai and the patients on
one Northwestern Unit were screened for psychiatric consultation. RESULTS:
The patients who received psychiatric liaison screening had a higher
consultation rate than those who received traditional consultation. The
rates of DSM-III disorders in the experimental year were 56% at Mount Sinai
and 60% at Northwestern. The mean length of stay was reduced from 20.7 to
18.5 days at Mount Sinai and from 15.5 to 13.8 days at Northwestern,
resulting in reductions in hospital costs ($647/day) of $166,926 and
$97,361, respectively. Fees generated from Medicare service delivery could
have paid for the $20,000 psychiatric intervention cost at each site. There
was no difference, however, between the two years in the discharge
placement of patients. CONCLUSIONS: Admission psychiatric liaison screening
of elderly patients with hip fractures results in early detection of
psychiatric morbidity, better psychiatric care, earlier discharge, and
substantial cost savings to the hospital.
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