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Proactive consultation: A new model of care in consultation-liaison psychiatry

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2. Rapid intervention that anticipates impending problems before a cascade of complications starts.

3. Collaborative engagement with the primary medical team, sharing the burden of caring for the complex inpatient, and transmitting critical behavioral management skills to all caregivers, including the skill of recognizing patients who can benefit from a psychiatric consultation.

4. Daily and close contact between behavioral and medical teams, ensuring that treatment recommendations are understood, enacted, and reinforced, ineffective treatments are discontinued, and new problems are addressed before complicating consequences arise. Dedicating specific personnel to specific hospital units and placing them in rounds simplifies communication and speeds intervention implementation.

5. A multidisciplinary consultation team, offering a range of responses, including informal curbside consultation, consultation with an advanced practice registered nurse, social work interventions, advice to discharge planning teams, psychological services, and access to specialized providers, such as addiction teams, as well as traditional consultation with an experienced psychiatrist.

Research has shown the effectiveness of proactive, embedded, multidisciplinary approaches.1-3,5 It was a gratifying experience to work in this model. I worked intimately with medical clinicians, and shared the burden of responsibilities leading to optimal patient outcomes. The proactive consultation model truly re-emphasizes the “liaison” component of C-L psychiatry, as it was originally envisioned.

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