Southwestern Vermont Medical Center has worked in the past with United Counseling Service to serve patients having a mental health crisis, said Dr. Trey Dobson, a specialist in emergency medicine and chief medical officer at SVMC. Those mental health professionals were mainly helping with disposition of the case, such as placement in an outpatient program or an inpatient facility.
The collaboration is aimed at addressing the fact that between 30 and 40 percent of patients with a medical issue also have a psychiatric diagnosis, Dobson said.
“The difference now,” Dobson said, “is that not only for these patients in crisis do we have a psychiatric provider available for treatment, but for patients that present to our facility for another, medical reason but have a contaminant psychiatric issue, we have access to psychiatrists and psychiatric practitioners.”
Dobson and Alya Reeve, an advanced practice registered nurse with the counseling service, said the partnership, which began in early May, has allowed earlier and more direct access to mental health consultations at the hospital and has helped in several ways to reduce stress among patients and medical staff.
“The response from medical staff and nursing staff has been overwhelmingly positive,” Dobson said.
Reeve said UCS practitioners come to the hospital during the morning hours, while medical staff members are going through the rounds of the emergency room, intensive care and inpatient units.
“What happens is that there are a few [cases] that come up that they need a consult, or we have already consulted,” she said, “and we are seeing whether medications are working and what the issues are.”
For example, Reeve said, a woman recently admitted for medical reasons also is a patient who is followed by the counseling service, “so we were able to get the case manager who works closely with that person to meet face-to-face with the nurse and the physician, so they know and are working closely on a discharge disposition together.”
In that instance, she said, UCS was able to provide important information about the patient’s ongoing medications, which someone at the medical center would have had to track down.
“That kind of communication that happens, it supports so that the psychiatric issue is not the focus of treatment,” Reeve said. “It allows the medical stabilization to occur.”
With another patient, the psychiatric medication the person was taking may have been a factor in a current medical condition, she said, so UCS practitioners were able to work with medical center staff on a solution.
Cross-practice communication is “how medicine works these days,” Reeve said.
She added, “There is a sign in the hallway that medicine is a team sport, and that’s an example.”
Having mental health providers meeting with medical staff on rounds, “it really gives them an idea of what patients are in the hospital this day, and what is going on with them,” Dobson said. “And the [medical] staff can ask questions and interact.”
The partnership provides for both daily hours of face time in the medical center and for after-hours consultation.
A major area of cooperation comes in working with patients in a mental health crisis and staying in the emergency department for an extended period. Personnel from both organizations consult on treatment to both stabilize the person and to plan a disposition program for the patient.
That includes, “how do we prevent [patients] from getting worse, how do we keep the staff safe, and how do we keep staff from getting burned out,” Reeve said. “So when you talk about consultation psychiatry, it’s not just a consultation about the patient. Patient care is about the staff providing support and assessment of the patient. A lot of our job is also looking at what does it take out of the nursing staff, and mental health workers, or security guards, in order to keep the environment safe for everybody.”
Sometimes, she said, there are several people with major psychiatric problems, with or without medical problems, in the emergency department, and throughout the hospital staff members often deal with stressful situations and have to make difficult decisions. That’s why meeting regularly with the medical staff is a key aspect of supporting the care process, Reeve said.
“You have really talented staff here, and the all work very hard, so being able to support them is very important,” she said.
“The psychiatric providers attend our daily interdisciplinary rounds, and we are able to access consults much more efficiently,” said Laurene Grande, director of Intensive Care Unit and Medical Surgical Nursing. “The dialogues we are having add a new dimension to the care we are able to provide.
“When someone has a medical problem,” Dobson said, “that can make a psychiatric problem worse, and it’s pretty rare that they remain separate.”
Reeve said that after she became medical director at UCS two years ago, she and Dobson began talking about the need to enhance psychiatric care at the hospital, and the partnership took about 18 months to develop.
SVMC once had an in-patient psychiatric unit and later retained consulting psychiatrists, but those positions had been lost over time, she said.
Dobson said the UCS employees, who are contracted to provide services at SVMC, all have significant clinical experience. In addition to consulting on patients, he said, they will assist with policy and guideline development, attend providers from many specialties during rounds, and conduct educational sessions for staff.
