Page numbers printed in boldface type refer to tables.
Accreditation Council for Graduate Medical Education (ACGME),67
ACGME.
See Accreditation Council for Graduate Medical Education
Achebe, Chinua,107
Activity therapistsas essential inpatient personnel,24
in interdisciplinary systems,89
Activity therapy, description of,146
Acute disorders.
See Agitation; Catatonia; Delirium; Mental health services; Psychosis; Violence
Acute dystonic reactions,181
Addiction psychiatry, accredited fellowships in,52–53
Administration.
See also Leadership; Legal issues
budget negotiations,96, 100
efficiency and revenue optimization,96–97
vignette,97
expectations of,83
facilities and environment,95
monetary negotiations,96
overview,79–80
patient satisfaction,98–99
process of restraint administration,235–236
quality improvement,98, 100
regulatory systems,94–95
roles,60–61, 80–81, 87
staff wellness,99
Admitting services,93
“Adrenaline junkie,”65
Adult Protective Services,227
Adultsbrain imaging in older adults,137–138
competency of,236
discharge to foster care,127
ECT in,148
elder abuse and abuse of vulnerable adults,232
Advance directives,228–229
Advanced practice providers, in interdisciplinary systems,87
Adverse events.
See also Legal issues
clinician support and,273–275
debriefing,274
support services,274–275, 278
vignette,275
description of,265–266, 278
event review,268–273, 278
action plans,272–273
vignette,273
event report and,271–272
individual performance reviews,272
medical errors,272, 278
root cause analysis of,271, 278
information gathering,270–271
level of review,268–270
vignette,269–270
mortality and morbidity conferences,275–277, 278
vignette,277
risk management response to,266–268
advice and protection,267–268
communication,266–267
legal action,268
overview,266
Aftercarechoices,22
discharge planning and,207–208
Aggression, due to medical causes,258
Agitation.
See also Violence
description of,167–168
etiology,168,
169evaluation,168
nonpharmacological interventions,168–170
pharmacological interventions,170
as safety issue,264
Akathisia, side effects of,181
Alcoholics Anonymous,207
“Alert fatigue,”160
American Association for Emergency Psychiatryrecommendations for de-escalation,169–170
American Institutions for the Insane,3
American Psychiatric Associationhistory of,3
list of measures pertaining to psychiatric practice,98
practice guidelines,156–157
recommendations for treatment of delirium,176
Anger management therapy, for inpatient treatment,20
Anticholinergic toxicity,182
Antidepressants,142
Antipsychotic medicationsdrug-drug interactions and side effects of,140–141
for treatment of agitation and violence,170
Aripiprazole, for treatment of delirium,176
Assault, risk assessment of,255
Association of Medical Superintendents,3
Attendings, residents as “junior attendings,”111–113
Autonomydescription of,216
legal issues of,220
Barrie, Valerie,ix, xii
Beck Depression Inventory,138
Beneficence, description of,216
Benzodiazepinesside effects of,181
for treatment of agitation and violence,170
for treatment of catatonia,178
The “borderline talk,”112–114
vignettes,113, 114
Brain imagingCT,135, 137
MRI,135, 137
in older adults,137–138
overview,135–136
suspicion of a general medical etiology,136–137
in young adults,137
Brain injury medicine, accredited fellowships in,53–54
Burnout,69–72
risk for,77
Carbamazepine, side effects of,183
Catatonia,137
description of,176–177
etiology,177
evaluation and diagnosis of,177–178, 183
pathophysiology,177
treatment,178–179
Centers for Medicare and Medicaid Services (CMS),15, 94, 98, 237, 238
Certificate of Need guidelines,82
Child abuse,231–232
Child and adolescent psychiatryaccredited fellowships in,48–49
brain imaging in,137
inpatient services for,81–82
Child Protective Services,227, 231–232
Chlorpromazine,155–156
side effects of,183
“Civil commitment,”218, 228
C-L.
See Consultation-liaison psychiatry
Clinical care.
See also Medications
acute disordersagitation,167–170
etiology,168,
169evaluation,168
nonpharmacological interventions,168–170
overview,167–168
pharmacological interventions,170
catatonia,176–179
etiology,177
evaluation and diagnosis of,177–178
overview,176–177
pathophysiology,177
treatment,178–179
delirium,173–176
etiology,174
evaluation and diagnosis of,174–175
overview,173–174
pathophysiology,174,
175treatment,175–176
overview,167
psychosis,179–180
definition of,179
etiology,179
evaluation and diagnosis of,179–180
pathophysiology,179
treatment,180
diagnostic and treatment modalitiesdiagnostic testing,134–140
brain imaging,135–138
laboratory tests,135,
135–
136medical issues,134
overview,134
psychiatric diagnoses,134–135
electroconvulsive therapy,147–148
individual and group therapy,143–147
activity therapy,146
cognitive-behavioral therapy,145
dialectical behavior therapy,145–146
motivational interviewing,146
overview,143
patient and family education,144–145
problem solving,144
psychodynamic psychotherapy,146–147
supportive therapy,143–144
medication management,140–143
for depression and suicide risk,142
for mania,142–143
overview,140
for psychosis,140–142
for risk of suicide,142
neuropsychological tests,138
overview,133
psychological and neuropsychological evaluation,139
tests of cognitive status,139
treatment response to,139–140
guidelines, algorithms, and order sets,165
compliance with,159–160
examples of,157
externally generated guidelines,156–158
internally generated guidelines,158–159
vignette,158–159
overview,151
payer expectations,161–163
clinical need,162
level of service,162–163
overview,161
patient acuity and,162
quality improvement and patient safety measures,163–165
regulatory requirements and guidelines,159–161
credentialing and oversight regulations,159–161
education,160
standardized procedures,160
vignette,161
role of evidence-based medicine,152–156
advantages of,153–156
limits of,152–153
overview,152
initial assessment,119–124
communication about delegation of work,124
discharge communication during first meeting,123
treatment planning,132
first impressions,120
goals,131
inpatient transition to outpatient care,126–129
knowledge of DSM-5 to guide questions,122–123
vignette,122
review of available medical records,121
structure and goals of the interview,121–122
treatment planning,124–131
collaboration with patient,126
difficult patient and,126
medication versus nonmedication,124–125
psychotherapy,125
violencefactors contributing to,171impulsivity-driven,171–172
predatory,172
psychosis-driven,172
overview,170–171
physical management of,172–173
Clinical tracks, versus tenure,73–74
Clinicians.
See also Hospitalists
reputation of,58
support during adverse event,273–275
Clozapine, side effects of,183
Cluster A personality disorders,179
CMS.
See Centers for Medicare and Medicaid Services Cognition, tests of cognitive status,139
Cognitive-behavioral therapydescription of,145
for inpatient treatment,20
Collaborative care,50, 59.
See also Consultation-liaison psychiatry; Teamwork
Committee roles,60–61
Communication.
See also Electronic medical records
about discharge during first meeting,123
about response to adverse events,266–267
consultation with colleagues,131
delegation of work during initial assessment of patient,124
with outpatient providers,197
with patients,7
“spiel” for residents,112
teamwork and,6–7, 90–91
vignette,90
Competencyin adults,236
description of,224–226
legal incompetency,228
Compliance,159–160, 188
Computed tomography (CT),135, 137
Confidentialityauthorization from the patient,236
breaking,230–232
in child abuse,231–232
in court reports and testimony,232
elder abuse and abuse of vulnerable adults,232
in emergency situations,230–231
imminent risk to harm oneself,231
imminent risk to harm others,231
description of,229–230
limitations to rights of privacy and autonomydescription of,232–233
safety precautions and limits of privacy,233
mental health and,230
Consent.
See Informed consent
Consultation-liaison (C-L) psychiatry,82–83.
See also Teamwork
accredited fellowships in,50–51
characteristics of,103
consult questions,35–36
description of,30–31
factors related to improved consultee satisfaction experience,249family and provider conflicts,39
integrated care in,248–250,
249mental health services,33–35
vignette,34–35
overview,29–30
relationship development with the health care team,31–35
overview,31
teaching and building,33
team preparation of common problems,31–33, 40
aggression and agitation,32–33
noncompliance,31–32
vignette,32
stigma toward mental health,38, 40
team building,37–38
building a skill set,38
multidisciplinary approach to,37
Continuing medical education,60.
See also Education
Continuity of care,189
description of,141–142
model of,212
Credentialing, oversight regulation and,160
CT.
See Computed tomography Culture, institutional,30–31, 40
Dalai Lama XIV,101, 102
DBT.
See Dialectical behavior therapy
Death.
See also Hospice and palliative medicine; Suicide
risk of,54
De-escalationAmerican Association for Emergency Psychiatry recommendations for,169–170
description of,168–169
Delirium,64, 137
APA recommendations for treatment of delirium,176
DSM-5 definition of,173–174
etiology,174
evaluation and diagnosis of,174–175, 183
as mnemonic “DELIRIUM,”174,
175overview,173–174
pathophysiology,174,
175treatment,175–176
Depressioninterventions,206
late-life,147–148
medication management of,142
Dermatology, reactions to psychotropic medications,183
Dialectical behavior therapy (DBT)description of,145–146
for inpatient treatment,20, 89
Disability,52.
See also Legal issues grave, 219–220
Discharge.
See also Inpatient services; Outpatient care; Safety
aftercare planning,207–208
communication about during first meeting,123
communication with outpatient providers,197
factors affecting,205–207
vignette,206–207
inpatient transition to outpatient care,126–129
adult foster care,127
consultation with colleagues,131
contingency plans,129
coordination of care with outpatient providers,129–130
discharge to family or friends,127
documentation of,131
homelessness,127
partial hospitalization program,127
postdischarge placement,132
residential treatment,128
returning home,126–127
subacute rehabilitation program,127–128
substance use treatment,128
unexpected course of,130–131
management in inpatient services,21
notes,197–198
of patients,94
planning,197, 199, 201–202, 260–261
follow-up and coordination,207–209
vignette,209
postdischarge period,212
readiness for,245
readmission,209–211
vignette,210–211
treatment planning,132
Divalproex,143
Documentation.
See also Electronic medical records
of inpatient transition to outpatient care,131
Dopamine D2 antagonists,177, 181
DSM-5criteria lists for in-hospital admission,191, 194
definition of delirium,173–174
for specific versus general diagnoses,198
Structured Clinical Interview for,138
use during initial assessment of patient,122–123
vignette,122
Eating disorders, education and training in,55–56
ECT.
See Electroconvulsive therapy
Education.
See also Continuing medical education
accredited fellowship training in psychiatry,47–53
apprentice model of medical education,107
consistency in training,8–9
of credentialing and oversight regulation,160
cross-training,82
general medical education,44–46
initiatives,76
internship and residency training,46–47
of patient and family,144–145
training and background overview,43–44
EEG.
See Electroencephalogram
Elder abuse,232
Electroconvulsive therapy (ECT),7, 10, 21, 84, 139
description of,147–148
education and training in,47, 56, 62
safety of,149
for treatment of catatonia,178, 179
Electroencephalogram (EEG),175
Electronic medical records (EMRs)algorithms and guidelines for,165
documentation,21–22
as a form of communication,90
review before initial assessment of patient,121
Elopement,257
Emergency services,52, 61, 66, 83–94
assessment,186–187
breaking confidentiality in,230–231
characteristics of,103–104
interviews,186–187
patient dangerousness in,256
security and,83–84
transitions from,188–189, 198
discharge to an inpatient unit,188–189, 198
discharge to outpatient care,189
transitions within,187–188
treatment planning,187
vignette,90
EMRs.
See Electronic medical records
Environmentsafety of,258
security,259
Epocrates,157
EPS.
See Extrapyramidal symptoms
Erikson, Erik,114, 115
Ethical issues.
See also Legal issues
involuntary admission to inpatient treatment,222–224
principles of medical ethics,216
suicide as a human right,220
Ethnicity, and race gap in quality improvement,247
Evidence-based medicineadvantages of,153–156, 165
vignette,155–156
best practices of,152–153
decisions with,154
limits of,152–153
overview,152
peer-reviewed,154
preferential use of,165
role of,152–156
Extrapyramidal symptoms (EPS),176
Familyduring an adverse event,267
emotional experiences of,65
provider conflicts and,39
Fellowships,47–53, 62
in addiction psychiatry,52–53
in brain injury medicine,53–54
in child and adolescent psychiatry,48–49
in consultation-liaison psychiatry,50–51
in forensic psychiatry,51–52
in geriatric psychiatry,49
in related fields,53–55, 62
Fluphenazine, side effects of,183
Forensic psychiatry.
See also Legal issues accredited fellowships in,51–52
Foster care, inpatient discharge to,127
Gabbard, Glen,115
Geriatric psychiatry.
See also Neuropsychology
accredited fellowships in,49
Group therapies, for inpatient treatment,20
Guardianship,52, 227–228.
See also Legal issues
Haloperidol, for treatment of delirium,176
Hamilton Depression Rating Scale,138
Handoffsregulations on information for,12
written,12
Health Insurance Portability and Accountability Act (HIPAA),229
Hematopoietic issues, as reactions to psychotropic medications,183
HIPAA.
See Health Insurance Portability and Accountability Act
Homelessness, discharge from inpatient transition to outpatient care,127
Hospice and palliative medicine, accredited fellowships in,54–55, 62
Hospital Based Inpatient Psychiatric Services Psychiatric Core Measures,98
Hospital programsdevelopment of new systems,84–85
partial,84
Hospitalist model,16
advantages of,6–10
communication and teamwork,6–7
consistency, expertise, and comfort with acuity,8–9
efficiency,9–10
vignette,6
challenges of,10–13, 16
discontinuity of treatment,10–11
handoffs,11–12
short-term perspective,12–13
vignette,10
general service issues in hospital care,13–15
insurance issues,14–15
legal issues,14
regulation,15
staffing for fluctuating demand,13–14
Hospitalist psychiatry, history of,3–5
Hospitalists.
See also Clinicians; Skill sets
advantages of the hospitalist model,6–10
as a career,ix–x
competence of,65
expertise of,65
individual performance reviews,272
medical errors,272
proficiency of,65
psychiatry services structure of,5–6
responsibility for patient safety,263
Infections, hospital-acquired,263
Informed consent.
See also Legal issues
capacity to,52
description of,225
elements of,225–226
in inpatient psychiatric treatment,226–227
with involuntary treatment,236
medical consent for treatment,225
Inpatient services,66, 81–82.
See also Discharge; Ethical issues; Legal issues
admission decisions,189–190, 198
consultations,196, 199
vignette,196–197
admission procedures,190–194
evening and weekend cross-coverage,194–195, 199
initial evaluation,190–193
admission notes,192–194, 198
vignette,192
team transitions,195
coordination of,92
critical versus optimal treatment,203–205
vignette,204–205
dangerousness in medical-surgical units,257–258
discharge management,21
communication with outpatient providers,197
discharge notes,197–198
from emergency services,188–189
planning,197
documentation,21–22, 27
ECT treatment,7, 10, 21
essential facilities,24–27
high-security areas,26–27
interview and activity space,26
locked and unlocked units,24–25
overview,24
room layout and features,25–26
essential personnel,23–24
ethical, legal, and practical considerations,222
evaluation,18–19
clarification of the problem,18
diagnosis,19
vignette,18–19
hospital-acquired infections,263
informed consent for treatment,226–227
involuntary patients,25
length of stay,202–203, 209–210
vignette,202–203
level of service,162–163
vignette,163
“medical clearance” of patients in,135
mission of,92
nonpharmacological methods of addressing inpatient issues,261–262
to outpatient care,185–186
overview,17
partial hospitalization program,127, 208
patient flow,93
pharmacological interventions,19–20, 27
psychosocial treatment,20–21
activity-based services,20–21
psychotherapy,20
readmission,209–211, 245
vignette,210–211
role in mental health care,211
safety,17–18
setting,251
severity of psychopathology in,212
“VIP” units,26–27
voluntary patients,25, 218
writing,22
Institute of Medicine Committee,238
Insurance issuescoverage and financial means of patients,45
demonstration that criteria still met for continued stay,15
to justify authorization,14–15
length of hospital stay,209–210
nonreimbursable services,37
Interdisciplinary systemsadvanced practice providers,87
psychiatrists,85–87
vignette,85
Internship,46–47
Interviews.
See also Motivational interviewing
about need for in-hospital admission,186–187
activity space for,26
for information gathering after an adverse event,270–271
private space for,26
structure and goals during initial patient assessment,121–122
vignette,121
Involuntary admission,25, 221–224, 236
ethical issues,222–224
informed consent with,236
patient-centered preventive crisis plan,244
quality improvement and,244
threshold for risk evaluation and preventive nature of,220–221
vignette,222
Jail,128–129
Job satisfaction,64–69, 77
loss of,70
The Joint Commission,15, 94–95, 237, 259, 265
Ketamine infusion, for inpatient treatment,20
Laryngospasm,181
Leadership.
See also Administration
description of,76–77
overview,79–80
partners and,100
patient flow and strategic choices,91–94
vignette,91
role in,74
vignette,76
Lectures,104–105
Legal issues.
See also Adverse events; Ethical issues; Forensic psychiatry; Restraint of free movement
advance directives,228–229
assumptions,216–217
breaking confidentiality in court reports and testimony,232
capacity to consent,52
“civil commitment,”218
competency,224–226
confidentiality,229–232
disability,52
familiarity with,16
guardianship,52, 227–228
Health Insurance Portability and Accountability Act,229
in inpatient services,81
involuntary admission,221–222, 222–224, 236
vignette,222
judicial system’s involvement to mandate inpatient treatment,223
law enforcement personnel,221
legal action in response to adverse events,267–268
living wills,228–229
malpractice suits,95
medical and legal grounds for coercive intervention,219–220
danger to others,219
danger to self,219
grave disability,219–220
mental health law,236
overview,215
for patient rights,14
powers of attorney,228–229
regulatory systems,94–95
threshold for risk evaluation and preventive nature of involuntary treatment,220–221
voluntary and involuntary treatment,217–219
LegislationHealth Insurance Portability and Accountability Act,229
Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015,237
Tarasoff laws,231
Lithium,143
Living wills,228–229
Lorazepam,156
for treatment of catatonia,178
Magnetic resonance imaging (MRI),135, 137
Malpractice suits,95
Managed care,237, 251.
See also Quality improvement Mania, medication management for, 142–143
Medical studentslevels of learning,109–110
orientation,106–107
rotation with,106–107
Socratic-type questions and,108
Medicare,98
Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015,237
Medicationscollaboration with pharmacists,13
drug-drug interactions and side effects of,140–141
efficacy of,19–20
fall risk with,262
inpatient selection of,19–20
versus nonmedication treatment planning,124–125, 132
patient safety and iatrogenic complications,261–263
psychotropic,149
safety of,246–247
selection in transition to outpatient care,12
side effects of,181–183
overview,181
psychotropic medications,181–182
Medscape,157
Mental health services.
See also Acute disorders
agencies,94
in C-L psychiatry,33–35
fallacies,38
hospital’s role in,211
medical issues and,134
stigma toward,38, 40
Mental status examinationfor in-hospital admission,191–192, 193–194
for symptoms in inpatient treatment,22
Mentorship,61–62
vignette,76–77
Merit-Based Incentive Payment System,98
N-methyl-D-aspartate (NMDA),179
Mini-International Neuropsychiatric Interview,138
Mini-Mental State Examination,139
Models.
See also Hospitalist model
advantages of the hospitalist model,6–10
apprentice model of medical education,107
of continuum of care,212
Psychiatric Emergency Services,6
structure of hospitalist psychiatry services,5–6
Montgomery-Åsberg Depression Rating Scale,138
Montreal Cognitive Assessment,139
Mood stabilizers,143
Mortality and morbidity conferencesafter an adverse event,275–277
vignette,276
Motivational interviewingdescription of,146
for inpatient treatment,20
MRI.
See Magnetic resonance imaging
National Committee for Quality Assurance,237
National Institute for Health and Care Excellencepractice guidelines,157
recommendations for treatment of delirium,176
National Institute of Mental Health (NIMH), practice guidelines,157
Neuroleptic malignant syndrome (NMS),178, 182
Neuropsychology.
See also Geriatric psychiatry
education and training in,57
NIMH.
See National Institute of Mental Health
NMDA.
See N-methyl-D-aspartate
NMS.
See Neuroleptic malignant syndrome
Nursesas essential inpatient personnel,23
in interdisciplinary systems,88
Olanzapine,155–156
for treatment of delirium,176
On-call duties,61
Organ transplants,53
Outpatient care.
See also Discharge
discharge from emergency services,188–189
from inpatient services,185–186
inpatient transition to,126–129
medication selection in transition to,12
Oversightcredentialing and,160
vignette,161
Oxcarbazepineside effects of,183
Pain medicine, nonpsychiatric training in,62
Paliperidone, side effects of,183
Partial hospital programs,84, 208
Paternalism, description of,216
Patient care,90–91.
See also Quality improvement
collaboration with patient about treatment planning,126
continuity of care,141–142
coordination of care with outpatient providers,129–130
inpatient to outpatient,185–186
patient and family education,144–145
Patient care workersas essential inpatient personnel,24
routines of,64–65
Patient Health Questionnaire,138
Patient safety.
See also Discharge
dangerousness to self and others,254–263, 264
aggressive behavior due to medical causes,258
assessment of,255
assault risk,255
suicide risk assessment,255
in the emergency department,256
environmental security,259
fall risk,262
hospital-acquired infections,263
inappropriate sexual interactions,260
in inpatient psychiatric units,258–260
vignette,258–259
in medical-surgical units,257–258
medication and iatrogenic complications,261–263
vignette,261
nonpharmacological methods of addressing inpatient issues,261–262
patient acuity,259–260
safety of the environment,258
suicide risk assessment,257–258
in transitions of care,256–257
vignette,256–257
description of,253–254
ECT and,149
elopement,257
imminent risk to harm oneself,231
in inpatient services,17–18
quality improvement and safety measures,163–165
vignette,164–165
Patients.
See also Restraint of free movement
acuity and,162, 259–260
aggression and agitation in,32–33
vignette,34–35
assessment of progress of,7
communication with,7
day-to-day progress of,110
difficult,126
discharge,94
emotional experiences of,65
evaluation,18–19
fall risk,262
financial means of,45
identification of,193
incarcerated,52
involuntary,25, 218–219
risk evaluation and preventive nature of treatment,220–221
legal rights of,14
medical and psychiatric history of,193
with medical comorbidities,92
noncompliance,31–32
patient-centered preventive crisis plan,244
quality improvement of,86, 165
patient safety measures and,163–165
relationship with,67–68
vignette,67–68
review of EMRs before initial assessment of,121
rights of privacy,232–236
satisfaction of,98–99, 245
seclusion and restraint,246
therapeutic process in presenting problems,27
treatment for suicidal patients,187
voluntary,25, 217–218
Pedagogy, role of teaching and supervision and,102
Peers, peer-reviewed evidence-based medicine,154
Perphenazine, side effects of,183
Personal support,70–71
vignettes,71
Pharmacists, medication collaboration with,13
Pharmacologyinterventions for agitation,170
interventions in inpatient services,19–20, 27
Physiciansforming “professional identities,”115
quality improvement of,86
role selection,87
well-being and burnout,69–72, 275
Police custody,128–129
Powers of attorney,228–229
Privacy, patient’s rights of,232–236
description of,232–233
restraint of free movement,233–236
safety precautions and limits of,233
Problem solving, description of,144
Promotionshospital-based activities leading to promotion,74–76
vignette,75
rank,73
tenure versus clinical tracks,73–74
Providersaccountability of,242
embedded,59
perceived influence of,243
Psychiatric Emergency Services model,6
Psychiatristsas essential inpatient personnel,23
in interdisciplinary systems,85–86
physician quality improvement,86
Psychiatry.
See also Consultation-liaison psychiatry
accredited fellowship training in,47–53
hospital-based,x, 4–5
Psychodynamic therapy, description of,146–147
Psychoeducation,36, 40.
See also Consultation-liaison psychiatry
for patient and family,144–145
Psychologists,40
in interdisciplinary systems,89–90
Psychopathology, in the inpatient setting,212
Psychosis,64
definition of,179
etiology,179
evaluation and diagnosis of,179–180, 183
medication managementcontinuity of care,141
overview,140
speed of response,141
pathophysiology,179
treatment,180
Psychosocial inpatient treatment,20–21
Psychotherapyeducation and training in,56
individual,20
in inpatient services,20
supportive psychotherapy as psychological training,110–111
in treatment planning,125
Psychotropic medications,149
side effects of,184
acute dystonic reactions,181
akathisia,181
anticholinergic toxicity,182
dermatological reactions,183
hematopoietic issues,183
neuroleptic malignant syndrome,182
serotonin syndrome,182–183
Publication,75
as opportunity for academic activity,77
Quality improvement,100
application of quality measurement,244–250
consultation psychiatry and integrated care,248–250,
249hospital readmission,245–246
involuntary admission,244
medication safety,246–247
patient satisfaction,245
race and ethnicity gap,247
seclusion and restraint,246
definition of,98
description of,237–238
developing consensus in core quality measures,250–251
goals and considerations in,240–244
accountability,242
continuum of quality measurement,241differential emphasis,242–243
feasibility and psychometric properties,240
patient selectivity,243
perceived provider influence,243
scope of focus,243–244
selection of quality measurement,242transparency,240, 242
patient safety measures and,163–165
vignette,164–165
of physicians,86
quality assessment and measurement,238–240
continuum of quality measurement from inputs to functional outcomes,241standards of,252
Quetiapineside effects of,183
for treatment of delirium,176
Race, and ethnicity gap in quality improvement,247
Rank, description of,73
Regulatory systems,94–95
Relationships.
See Consultation-liaison psychiatry; Skill sets; Teamwork Remen, Rachel N.,44
Research,62
publication,75
Residency,46–47
communication “spiel” for residents,112
as “junior attendings,”111–113
opportunities in hospital psychiatry,109–110
rotation with,106–107
strengths and challenges of,110
supportive techniques of,111
Residential treatment,128
Restraint of free movement.
See also Safety
description of,233–234
process of restraint administration,235–236
restraint devices,235
seclusion or environmental restraint,234
therapeutic or physical hold,234–235
Rights of privacy,232–236
Risperidone, side effects of,183
Roberts, Laura Weiss,107
“Root cause analysis,”18
Safety.
See also Discharge; Medications; Restraint of free movement
checks,233
court-ordered treatment and,236
imminent risk to harm oneself,231
imminent risk to harm others,231
for in-hospital admission,192
in inpatient units,26–27
locked inpatient psychiatric units,233
of medication,246–247
precautions and limits of rights of privacy,233
quality improvement and patient safety measures,163–165
security at emergency services,83–84
security cameras,233
Schizophreniainterventions,206
vignette of,10
Securityenvironmental,259
high-security areas,26–27
“Sentinel events,”265, 269.
See also Adverse events
Serotonin syndrome,182–183
Sexual behavior, inappropriate sexual interactions,260
SJS.
See Stevens-Johnson syndrome
Skill setsbuilding,38
career development in the hospital settingjob satisfaction,64–69, 77
autonomy and control,68–69
competence, proficiency, and expertise,65
patient relationship,67
routines of care,64–65
vignette,66
overview,63–64
sense of purpose,66
work environment,68
physician well-being and burnout,69–72
overview,69
personal support,70–71
vignettes,71
recognition and treatment,70–72
screening tools,70
sources and consequences of,69–70
workplace modification,71–72
vignette,72
professional growth, promotion, and leadership,72–77
defined responsibilities,72–73
description of,72–73
leadership,76–77
vignette,76
promotion,73–76
teaching,75–76
teaching and supervisionthe “borderline talk,”112–114
vignettes,113–114
characteristics of,103–104
directive teaching versus collaborative teaching,107–108
as a generative endeavor,115
levels of learners,109–110
medical students,109
niche for teachers,114
vignette,114
opportunities in hospital psychiatry,104–106
individual supervision,105–106
lectures and group sessions,104–105
residents,109–110
pedagogic role of,102
residents as “junior attendings,”111–113
rotation with a resident or student,106–107
supportive psychotherapy as psychological training,110–111
training and backgroundaccredited fellowship trainingin psychiatry,47–53
in related fields,53–55, 62
administrative and committee roles,60–61
continuing medical education,60
in eating disorders,55–56
in electroconvulsive therapy,56
embedded providers and,59
general medical education,44–46
internship and residency training,46–47
in management,80
in neuropsychology,57
on-call duties,61
overview,43–44
personal relationships and,57–59
in psychotherapy,56
research and,62
supervision and mentorship,61–62
Sleep medicine, accredited fellowships in,55, 62
Smith, Frank,104, 106
Social Security,144
Social workers,40
as essential inpatient personnel,23–24
in interdisciplinary systems,88–89
Socratic-type questions,108
Staffingexpectations of,93–94
in hospital care,13–14
time management and,5
State hospital,128
Steiner, George,101, 102
Stevens-Johnson syndrome (SJS),183
Structured Clinical Interview for DSM-5,138
Subacute rehabilitation program, discharge from inpatient to,127–128
Substance use disorders (SUDs)relapse to,128
training in,52–53
Suicide,64–65.
See also Death
assessment of suicidality,264
as a human right,220
medication management for risk of,142
rating scales for,139–140
risk assessment of,255, 257–258
treatment for suicidal patients,187
vignettes of,6, 18–19, 164–165
Supervision.
See also Skill sets
individual,105–106
learner-centered approach to,108
vignettes,113
Supportive therapy, description of,143–144
Tarasoff laws,231
Teachersin interdisciplinary systems,89–90
levels of learners,109–110
niche for,114
Teachingadjusting,115
collaborative learning,116
directive versus collaborative,107–108
positive effects of,116
Teamwork.
See also Consultation-liaison psychiatry
admission procedures in transition to inpatient services,195, 199
communication and,6–7, 90–91
vignette,90
of inpatient treatment team,27
preparation of common problems,31–33, 40
relationship development with the health care team,31–35, 62
team building,37–38
Tenure, versus clinical tracks,73–74
Texas Medication Algorithm Project,157
Therapeutic process, in patient’s presenting problems,27
Thioridazine, side effects of,183
Traineesconsistency in training of,8–9
training in management,80
Transcranial magnetic stimulation, for inpatient treatment,21
Treatment Alternatives to Relieve Depression,157
Trifluoperazine, side effects of,183
Up-to-Date,157
U.S. Agency for Healthcare Research and Quality–sponsored Patient Outcomes Research Team practice guidelines,157
U.S. Department of Veterans Affairs,63
U.S. National Quality Strategy,238
Vagus nerve stimulation, for inpatient treatment,20
Vignettesof advantages of hospitalist model,6
of adverse event action plan,273
of adverse event review,269–270
of the “borderline talk,”113–114
of challenges of hospitalist model,10
of clinician support services after an adverse event,275
of C-L psychiatry,3–35
of communication and teamwork,90
of consultations for admission to inpatient services,196–197
of credentialing and oversight,161
of critical versus optimal treatment,204–205
of efficiency and revenue optimization,97
of emergency services,90
of evaluation of inpatient services,18–19
of evidence-based medicine,155–156
of factors affecting discharge from inpatient services,206–207
of follow-up planning and coordination of discharge,209
of guidelines for standard of treatment,158–159
of hospital-based activities leading to promotion,74–76
of initial evaluation for inpatient services,192
of interdisciplinary systems,85
of interview during initial patient assessment,121
of involuntary admission,222
of knowledge of DSM-5 to guide questions,122
of leadership,76–77
length of hospital stay,202–203
of level of service,163
of mentorship,76–77
of mortality and morbidity conference,275
niche for teachers,114
of patient aggression and agitation,34–35
of patient flow and strategic choices,91
patient medication safety,261
patient noncompliance,32
of patient relationship,67–68
patient safety in inpatient psychiatric units,258–259
of patient safety measures,163–165
in patient transitions of care,256–257
of personal support,71
of publication,75
of readmission to inpatient services,210–211
of schizophrenia,10
of sense of purpose,66
of suicide,6, 18–19, 164–165
of supervision,113
of workplace modification,71–72
Violence.
See also Agitation
factors contributing to,171impulsivity-driven,171–172
predatory,172
psychosis-driven,172
overview,170–171
physical management of,172–173
“VIP” units,22
“Welfare check,”220
Well-beingof the physician,69–72, 275
positive factors of,77
Wellness, of staff,99
“White noise,”22
Workplaceenvironment,68
facilities and environment,95
modification of,71–72
vignette,72
World Health Organization,248, 253
Writingto an appropriate audience,22
publication,75, 77
vignette,75
well,22
Zolpidem, for treatment of catatonia,179
