Jeffrey S. Hammer

The timing of psychiatric consultation in the general hospital and length of hospital stay

Four hundred nineteen consecutive consult cases were studied to determine the relationship of the timing of the consult to hospital length of stay. Results indicated that earlier consultations predicted shorter lengths of stay. Applications of the present methodology to more complex evaluations of psychiatric consultation are discussed.

Occupational stress within the paramedic profession: An initial report of stress levels compared to hospital employees

We report a study of occupational stress in 374 paramedics. Results indicate that this profession experiences a high degree of job-related stress relative to other medical personnel. In a component analysis of this stress the results show that job stress manifests itself as job dissatisfaction, organizational stress, and negative patient attitudes, but not as frequently as somatic distress.

A follow-up report of occupational stress in urban EMT-paramedics

A survey completed by 280 nonvolunteer, urban emergency medicine technician (EMT)-paramedics revealed high levels of occupational stress. We used a four-component model of occupational stress in medical environments to show indications that much variation in the manifestation of stress was accounted for by the rank and job description of the EMT-paramedic, the district served by the EMT-paramedic, and the patient population served by the EMT-paramedic. Stress exhibited by field EMT-paramedics tended to manifest in more negative attitudes toward patients, whereas administrative-level paramedics exhibited more organizational stress. We noted that the age of the EMT-paramedic and the length of time employed as an EMT-paramedic correlated with the level of occupational stress (P less than .05). The recent occurrence of significant life events also was significantly related to the level of stress (P less than .05). An EMT-paramedics gender, marital status, and number of calls per shift had no significant correlation to the level of occupational stress. Based on these results, we recommend tailoring occupational stress programs to meet the needs of individual EMT-paramedics. Special attempts should be made to identify and counsel EMT-paramedics who are undergoing stressful life events. Finally, we suggest that rotating EMT-paramedics through various districts on a regular basis may help alleviate the negative impact on patient care in areas that have been identified as particularly stressful. Further studies are needed to verify our hypothesis.

Interventions in consultation-liaison psychiatry: The development of a schema and a checklist for operationalized interventions

A literature review and pilot investigations reveal that (ward-) management consultation-liaison (C/L) psychiatry recommendations are infrequent and unsystematically used. Furthermore, the communication with the operational group as defined by Meyer and Mendelson is not sufficiently activated. The major focus of the consultation is the first contact, but follow-up is infrequent. With the exception of biologic recommendations and disposition, chart notes by psychiatric consultants do not sufficiently specify the actions to be taken by the ward staff in a general hospital. A schema for the systematic organization of the intervention was developed. A checklist of operationalized C/L interventions is reported. This combination provides a tool for the systematic use of strategic ward management and discharge recommendations. Its basic structure is currently integrated in MICRO CARES [Hammer et al, SCAMC]. The impact on clinical care, education, and research is described.

Psychiatric Co-morbidities and Patients with Head and Spinal Cord Trauma Effects on Acute Hospital Care"

Three hundred twenty-one patients with traumatic head and spinal cord injuries were studied. Forty-two of these patients (13.1%) received psychiatric consultation services. Two types of consultation patients were identified--one receiving psychiatric consultation services in the acute-care hospital and one receiving psychiatric services in the post-acute care, long-term rehabilitation center. In order to assess the impact of psychiatric co-morbidities on hospital length of stay and charges, 40 consultation patients (23 acute and 17 rehabilitation) were matched to 87 control patients who received no psychiatric services. Matching was done on severity of injury, age, and sex. Psychiatric consultation cases had significantly longer stays than did matched controls. There were no differences on total charges.

Measurement of occupational stress in hospital settings: Two validity studies of a measure of self-reported stress in medical emergency rooms

The present study details the development of a stress scale for medical personnel. The Medical Personnel Stress Scale is a 48-item subjective stress measure capable of assessing both organizational and individual dimensions of stress. It demonstrated both the ability to discriminate between divergent medical emergency room organizations and to predict self reported on-the-job difficulties.

Consultation-liaison psychiatry and cost-effectiveness research. A review of methods

In light of the increasing emphasis on cost-effectiveness evaluations of consultation-liaison interventions, it becomes important for researchers to be cognizant of the available statistical methods. With this in mind, the present article reviews eight strategies of cost-effectiveness research and discusses their relative strengths and liabilities.

Consortium-Based Consultation/Liaison Research: Commentary and Perspective

Although a consortium approach for clinical trials is a common research strategy which has made important contributions in other disciplines in medicine, to date it has not been employed for research efforts in the consultation/liaison setting. There are several reasons for this: the relative newness of the field, lack of administrative control over patient care, and the unavailability of a standard methodology that could be adapted to multiple sites. Four basic research strategies can be employed within the framework of a research consortium to advance scientific knowledge in consultation/liaison psychiatry: 1) prevalence studies of psychiatric morbidity in medical settings; 2) interrelationship among psychiatric and medical conditions; 3) the outcome of psychiatric interventions within medical milieu; and, 4) cost-benefit evaluation. A field-tested computerized database protocol and a software system useable on an office-based microcomputer were employed to obtain standardized data across multiple training sites. The advantages and disadvantages of consortium studies are described.

Toward the integration of psychosocial services in the general hospital. The human services department

This article describes an innovative administrative organization for the delivery of psychologic care in the contemporary teaching hospital that, by combining services under medical leadership, takes an evolutionary beyond multidisciplinary team approaches. The long-range goal of this organization is to provide cost-effective psychosocial services in the general hospital while maintaining the unique role contributions of the participating disciplines. To allow for informed decision making in this process, the initial step has been to establish a collaborative data base for patient and staff tracking, program planning, and evaluation.

The Impact of a Prospective Payment System on Psychosocial Service Delivery in the General Hospital

the ability to estimate hospital length of stay accurately, the implications for medical education, resulting changes in health status at discharge and the fairness of this strategy across disparate treatment sites. Others have expressed concern that the economic constraints placed on medical decisionmaking may have negative effects on the quality of hospital care.7 Less discussion has centered on the impact of this payment system on consultative and ancillary hospital services. This is a particularly important issue with regard to psychosocial services because the DRG system makes no specific provision for any but the most debilitating psychiatric comorbidities (e.g., schizophrenia). Recent reserach has documented a positive relationship between psychological (e.g., distress) and social (e.g., living alone) factors and the utilization of medical services8-10 and