Assistant Professor, Section of Hospital Medicine Children's Hospital Colorado Denver, Colorado, United States
Background: Youth with mental and behavioral health conditions often present with unrecognized or under-treated acute an/or chronic physical health conditions. Little consensus exists regarding models of care needed to best address physical health co-morbidities among pediatric patients admitted to a psychiatric hospital. This study uniquely quantifies the physical health complexity of this patient population. Objective: To understand the prevalence and complexity of physical health co-morbidities among patients admitted to a pediatric psychiatric hospital and to inform what pediatric care models are necessary to address these needs. Design/Methods: From April-August 2023, a retrospective chart review of 100 patients was conducted at a 30-bed pediatric psychiatric hospital. Any patients admitted to either the inpatient psychiatric or neuropsychiatric special care units were eligible. Charts were reviewed for pre-existing physical health co-morbidities, physical health medications on admission, physical health co-morbidities diagnosed during admission, and orders in the evaluation and/or treatment of these conditions. Charts were reviewed for presence of pediatric hospital medicine (PHM) involvement. Subject matter experts reviewed charts to determine if PHM involvement may have been beneficial. Data was analyzed using descriptive statistics. Results: Of the 100 charts reviewed, 83% had at least one pre-existing physical health co-morbidity documented at the time of admission (median = 2, range 1 to 10) and 52% presented with a physical health medication by history. Among the 53 patients with new physical health co-morbidities diagnosed during admission, the following complex condition categories were most frequently seen: 1) Gastrointestinal 30% (n=20); 2) Metabolic 18% (n=11); Respiratory 12% (n=8); Urologic/Renal 6% (n=4). A new physical health medication was initiated in 47% of admissions. A PHM provider was involved in the care of 25% of admitted youth. Among the 75% who did not receive PHM involvement, 73% likely would have benefited from PHM assessment based on the medical complexity.
Conclusion(s): Holistic approaches to patient care place equal value on physical and mental/behavioral health needs. As the complexity and volume of child and adolescent psychiatric admissions increases, there is a growing and urgent need for the inclusion of pediatric providers among inpatient psychiatric care models, either in a consultative or co-management role. This requires dedicated educational curricula for providers and pharmacists working in the integrated pediatric psychiatric space.
