Psychotherapy & Liaison Skills
All consultation-liaison (C/L) psychiatrists encounter hospitalized and emergency department (ED) patients with nowhere to go--so called “dispo disasters.” Disposition from the hospital may be complicated not only by pathology--for example, dementia, developmental disability, capacity impairment, or factitious disorders--but also social circumstances including insurance, legal status, criminal history, or guardianship.(1) Regardless of cause, dispo disasters induce frustration among providers and patients who struggle on how to care for patients who “don’t need to be here.” Moreover, prolonged hospitalization puts patients at risk for delirium, infection, falls, and other iatrogenic pathology.(2)
In this session presented by the Emergency Psychiatry SIG, we present challenging disposition cases and strategies for managing them. Speakers introduce strategies for maintaining productive liaison relationships with primary teams, ensuring the patient’s ongoing care needs are met, and perhaps most rewardingly, getting the patient out of the hospital!
Presenters work in EDs, general hospitals, and inpatient psychiatry and boast extensive experience working across health and social systems. Each speaker presents a challenging case, for whom our panel tries to find a disposition.
A case of an ED patient with an infection and awaiting surgery helps attendees develop disposition plans under the time and resource constraints of the ED environment. Community disposition options the role of capacity in disposition are introduced.