1. TWENTY YEARS OF CONSULTATION-LIAISON PSYCHIATRY IN OURENSE. 1996-2016.
TWENTY YEARS OF CONSULTATION-LIAISON PSYCHIATRY IN OURENSE
Ortiz R (1); Carcavilla C. (1) Balseiro E. (1), Gómez-Reino I. (3) Simón D. (3) González H. (2).
Psychiatry Training. (2) Clinical Psychology. (3) Psychiatry.
Psychiatric Service. Complexo Hospitalario Universitario de Ourense. .
AIMS
METHOD
To describe the history of the Consultation-Liaison Psychiatry in our hospital from the beginning of liaison team to the present.
To present the teaching activity that is carried out in relation to the training in Psychosomatic and Liaison Psychiatry in our area.
Clinical data in Liaison Psychiatry from hospital activity reports ( ) were reviewed to know global referrals data.
We have reviewed the available reports of teaching activity in our Psychiatry Department to indicate the teaching activity in relation to Psychosomatic and Liaison Psychiatry. 1
Graphic 1
Graphic 2
Table 2
Table 1
Photo 4
Photo 3
RESULTS
In 1996, the activities of a consultation-liaison program to general medical, and surgical wards began in our hospital. Prior to this, the two Ourense hospitals (Santa Maria Nai and Cristal) gave puntual attention to the psychosomatics needs in general wards. In those times there was not a real consultation-liaison program dealing with specific work nad personal needs. In that year, the number of hospital admissions was slightly above 27,000 and the percentage of requests for intervention barely exceeded 1%.(Table 1)
The Unit emerged with a psychiatrist who also dealt with emergencies in the morning, with no liaison programs and no place to see patients or just meeting to discuss patients' cases. Psychiatry residents stopped going outside the area to do the rotation that was set for four months according to the Ministry's recommended Curriculum content for C-L Psychiatry training. Nowadays, the hospital has 854 general beds, distributed in two buildings (Santa Maria Nai Hospital and Cristal Hospital), located next to each other (Photo 1). In a few months, the new hospital building will be inaugurated and will be moved all the areas to a single building. (Photo 2).
The unit currently has a clinical psychologist, who performs two days of external consultations in an Acquired Brain Injury Program and three days of general consultation that combines care with the Occupational Health Program. It also has a psychiatrist who attends four days a week the general consultation and 1 day a week psychiatric emergencies and the Electroconvulsive Therapy Program. We have two offices with computer equipment for consultation and meetings as well as a mobile phone to receive the ICs with an SMS and urgent requests by telephone call. During holidays and afternoons the ICs are performed by the on call team (1 Psychiatrist and 1 MIR Psychiatrist). Since 2013, electronic request for consultations has been implemented.
There was a significant increase in the number of request for interventions from 278 in 1996 to 644 in 2016, with percentages of total hospital admissions ranging from less than 1% to over 2.57%. Global data about clinical activity could be seen at Graphic 1, 2 and Table 1, 2.
Among the documents of the unit we have a datasheet (last version December 2016) and another follow-up of patients (Photo 3 an 4).
In relation to teaching, the Service has 2 Psychiatric residents/year (training four months in PG2, and after that trainings in Neurology, Hospitalization, Emergency and Primare Care), 1 Clinical Psychology resident/year (training 6 months) and 2/year Mental Health Nursing Residents, that have their own training, out of the hospital because we have not Liaison Psychiatric nurse. We also have Family and Community Medicine residents (10/year), who perform a mandatory training of two weeks.
In January 2009, training guidelines for psychiatry were approved and released on the first edition and in March 2016, the third one. The latest edition formed the basis for the elaboration of the article, together with Zaragoza Psychosomatic Unit, where a proposal for MIRs training guidelines in our country was made. Also in collaboration with others Galician units, a book on training in Consultation-Liaison Psychiatry (Gómez-Reino Rodríguez I. Aspectos psiquiátricos y psicológicos del paciente médico-quirúrgico. Ed. Fundación Cabaleiro Goas. Complexo Hospitalario de Ourense. 2008; ISBN ) was prepared, with a future second edition soon, (Photo 5) which could be consulted in our Educational Unit website. (
Since 2013, specific training courses have been held for residents, focus on specific aspects of C-L Psychiatry, according to a guide previously elaborated by the staff of C-L Unit, with the following sections: Learning aims, Key points, Comments on book chapters and recommended papers, complementary teaching material (web pages, presentations etc.) and Extension Bibliography.
Photo 1
Hospital Cristal CHUO
Photo 2
CONCLUSIONS
There has been a significant increase in activity from 1996 to the present.
The increase in staff in 2007 and 2014 represented a considerable increase of clinical activity.
It is necessary to increase liaison programs with new areas such as Cardiology, Digestive and Obstetrics to improve the activity of the unit.
We must maintain and expand existing training programs by seeking accreditation to advanced studies in Consultation- Liaison Psychiatry and Psychosomatic .
No conflicts of interest reported by authors.
Photo 5