A Model of Inpatient Child and Adolescent Care Using a Consulting Psychiatrist

Since 1976 a child and adolescent unit in a public psychiatric hospital has used a part-time child and adolescent psychiatrist to improve inpatient treatment. In this model the consultant is directly responsible for all admission and discharge decisions. The consultant provides only essential medical treatment, which includes assessing, monitoring, and evaluating patients and prescribing medications, and directs patient care through nonmedical primary clinicians. A senior nurse coordinates on-site scheduling, confirms orders, documents treatment changes, and routinely phones the consultant with clinical updates. The consultant enhances the skills and performance of hospital staff and local physicians through case consultation and other interchanges. The authors recommend the model for the public sector because it increases the possibility of recruiting private-sector psychiatrists into the public system.