Critical Care Psychiatry SIG Launched

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Critical Care Psychiatry SIG Launched

‘Critically ill patients represent a high-yield target for psychiatric intervention’

The Academy’s Board has approved formation of another special interest group.

The Critical Care Psychiatry SIG is chaired by José Maldonado, MD, FACLP, chief, Critical Care Psychiatry Service, Stanford University.

José Maldonado, MD, FACLP
José Maldonado, MD, FACLP

“Historically, C-L Psychiatry services have provided disproportionally fewer consults to patients in the intensive care unit (ICU) setting compared with more conventional inpatient environments,” he says.

“However, critically ill patients represent a high-yield target for psychiatric intervention, as they routinely have comorbid psychiatric and substance use diagnoses, are frequently exposed to pharmacotherapy regimens familiar to C-L psychiatrists, and exhibit symptoms and conditions which are commonly managed by psychiatric providers.”

Furthermore, he adds, targeted interventions to provide early psychiatric intervention to critically ill patients demonstrate reductions in length of stay, leading to substantial financial savings given the high cost associated with the ICU environment.

Qualitative studies of such interventions also demonstrate they are well-received by ICU providers and decrease perceptions of burnout among ICU team members.

“Models of care which prioritize co-location of psychiatric care, psychiatric liaisons within the ICU, or early screening and psychiatric intervention among ICU patients are increasingly being implemented by C-L Psychiatry services, however currently there is not a platform to facilitate collaboration among such like-minded individuals and services.

“We believe a Critical Care Psychiatry SIG will provide the appropriate forum for such individuals to connect, collaborate, and launch the creation of a novel sub-field within the field of C-L Psychiatry.”

In September 2018, Dr. Maldonado and colleagues developed a Critical Care Psychiatry Service at Stanford University Medical Center which has steadily grown in its popularity and scope, now serving all 10 critical care units.

This collaboration has led to the development of instruments for the accurate diagnosis of delirium (i.e., the Stanford Proxy Test for delirium, a protocol for the prevention and management of delirium (the REMS-D Protocol), and a new pharmacological treatment management for patients on extracorporeal membrane oxygenators (ECMO) (i.e., Protocol for Pain, Sedation, and Delirium Management of ECMO Patients).

Similar liaisons have begun to develop nationwide, including at Brigham and Women’s Hospital, Columbia University, Vanderbilt University, Johns Hopkins University, and Virginia Commonwealth University.

“Critical Care Psychiatry partnerships in these institutions have also become an integral part of residency and fellowship education, exposing trainees to the highly specialized ICU environment with all of its attendant medications, interventions, devices, and its continual emphasis on interprofessional collaboration,” says Dr. Maldonado.

“While the clinical complexity of the ICU produces a steep learning curve for trainees and psychiatric providers, the potential benefits to patients, institutions and C-L psychiatrists readily demonstrate the inherent worth of developing and supporting such intrinsically valuable collaborations.”

To join this or another SIG, visit the Academy website here.


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