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Ahead of the Curve

This is a novel way of delivering psychiatric services in a general hospital.  Hochang 'Ben' Lee, MD

Some hospital patients may develop psychiatric symptoms that can interfere with their medical care and safety. Conversely, patients with mental disorders can develop medical issues that require hospitalization. Agitated delirium, for instance, can be triggered by surgery or acute medical treatment for chronic illnesses such as cancer. In an innovative shift, multidisciplinary teams at Yale-New Haven Psychiatric Hospital have developed the Behavioral Intervention Team (BIT), a program to screen patients for behavioral issues as they’re being admitted to the medical units at YNHH. Developed by William Sledge, MD, YNHPH’s Medical Director, the BIT is now being considered for implementation in a variety of hospitals around the country for its demonstrated favorable impact on the care of hospitalized medical patients.

“Traditionally, inpatient medical teams called and requested a psychiatric consultation, only after encountering urgent psychiatric barriers in the care of their patients,” says Hochang “Ben” Lee, MD, a consultation-liaison psychiatrist at YNHPH and Director of Psychological Services at Yale-New Haven Hospital.

“The traditional model was reactive. A preventable and manageable psychiatric issue often had become a psychiatric emergency by the time the consultation request was made. Once that psychiatric issue became a serious barrier in medical care, it was difficult to be removed, causing delays and compromising quality of care. With the BIT program, however, we now screen patients for potential psychiatric and behavioral issues right when they are admitted, first through their medical charts and then through discussions with the nurses and doctors caring for them.”

If it is determined that behavioral intervention might be needed, the multidisciplinary BIT dispatches a psychiatrist, an advanced practice registered nurse, a clinical specialist nurse or a psychiatric social worker to the patient and the primary medical team. “We want to be more proactive than reactive,” Lee explains. “This multidisciplinary model is about sending different levels of behavioral health specialists according to the psychiatric needs of medical patients with behavioral issues in the hospital.”

The BIT reflects ongoing changes at YNHH in how psychiatric care is managed and new ways of providing care in the clinical arena. “This is a novel way of delivering psychiatric service in a general hospital,” Lee says of the team model, “although it’s very much in line with the integrated care philosophy spreading across our country.”

The mission and goal of the BIT is to identify and prepare for problems before they occur. “For instance, if we can anticipate that a cardiac transplant patient may develop severe depression, we should be right there instead of waiting for a crisis to arise,” Lee states.

After the team evaluates and addresses the psychiatric issue for each patient, a BIT member will follow up with the primary medical team “to be sure the patient receives the excellent health care that he or she deserves,” Lee says. “So this model is about advocating for patients with mental disorders, too—which is all part of what integrated care means at Yale-New Haven.”

Yale School of Medicine
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