Hospitalists don the psychiatry hat

Psych beds are closing and psychiatrists are giving up hospital visits, leaving psychiatric inpatients underserved. Enter the hospitalist. Hospitalist groups, according to an article in Today’s Hospitalist, all too often become the default service for the care of these patients. But are hospitalists qualified?

When psychiatrists aren’t available, Dr. George points out, “some hospitalists are not comfortable prescribing the initial dose of certain psychiatric medications, like the newer antipsychotics.” While most hospitalists may be comfortable starting patients on antidepressants, “much further beyond that and their comfort level goes away.”

The problem surfaces in two ways. If the admitting hospital lacks psychiatric services the hospitalists often are called on to admit, bed and board the patient, attend to any acute medical needs and await placement in a suitable facility. If the hospital has psychiatrists on staff hospitalists are often called on to co-manage (there’s that buzz word again) those patients. Just as in the co-management of surgical patients, the arrangement creates problems if the lines of responsibility aren’t defined in stone.

What are the solutions? Some hospitalist groups have wisely demarcated the boundaries of their responsibility. Others are starting psychiatric hospitalist programs. The article discusses the ins and outs.