Consult-Liaison Psychiatry Services

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The Consult-Liaison Psychiatry Services (CL Services) provides psychiatry and substance abuse consultations to inpatients at BMC including those patients on medical/surgical floors, dialysis patients, transplant patients and outpatient medical/surgical cases. Psychiatrists, researchers and psychosomatic fellows in CL Services are engaged in a range of research initiatives in the field of psychosomatic medicine

ICU Delirium Quality Improvement (QI) Initiative
The goal of this quality improvement initiative is to develop a protocol that clinical teams can follow to optimize the management of delirium patients and standardize the prevention and treatment of ICU (intensive care unit) delirium across our institution.  In a prior phase of this QI research, we completed a baseline assessment of delirium management by nurses in the ICU. In response to these results, we are initiating the second phase of this quality improvement initiative, which is focused on delirium prevention and treatment. This phase involves creating an ICU delirium prevention and treatment algorithm, updating the current BMC Pain, Agitation, and Delirium Medication Guidelines, expanding the availability of pharmacologic and non-pharmacologic interventions, and conducting provider education on the prevention and treatment of ICU delirium.
Principal Investigator: Yadira Alonso, MD

Simulation Center Initiative
The goal of this project is to develop and evaluate a psychiatric clinical simulation curriculum. The initial aim is to improve psychiatric residency education by providing residents with the opportunity to manage various common clinical scenarios during a behavioral emergency prior to being on-call. During the simulation sessions residents will be given feedback in near real-time for debriefing, with the goal of improving resident confidence and knowledge. This project is driven by a team of psychiatry residents who are using quality improvement (QI) methodology to study the impact and outcomes of the clinical simulation initiatives. The QI study includes a baseline needs assessment across the psychiatry residents as well as data collection prior to and after the clinical simulation. Ultimately, we hope to show that psychiatric clinical simulation is a useful tool to use in psychiatric residency training, especially in a consult and liaison psychiatric setting.
Principal Investigator: Yadira Alonso, MD

Pathways to Homelessness and Improved Health Care Access for Homeless Older Adults
Homeless older adults are a vulnerable cohort, with high rates of medical and mental health care needs, reduced life expectancy and high utilization of medical and social service resources. We are conducting a qualitative study with homeless adults aged 50 years and older receiving acute inpatient medical care at BMC. Interviews will focus on identifying how this cohort of older adults became homeless, challenges they faced in accessing medical and mental health care prior to becoming homeless, and current care needs now that they are faced with homelessness. Gaining a greater appreciation of the pathways leading to homelessness among older adults can assist in identifying key barriers to accessing medical care and inform the development of medical and mental health care services for this population. A further aim of this study is to highlight the potential role of consultation liaison psychiatry to serve as a link, facilitating the engagement of this complex patient population in both medical and psychiatric care.
Principal Investigator: Kaila Rudolph, MD