GME Patient Safety Quality and Innovation Symposium

Issues Addressed/Background:  Collaborative care between psychiatry, psychology, and primary-care providers is imperative for ensuring patients receive appropriate mental health care. In the hectic academic system, there can be uncertainty in navigating referrals, both between the Departments of Family Medicine and Psychiatry/Psychology, as well as internally within the Department of Psychiatry. In the primary care settings, there can be a level of confusion regarding how to most appropriately refer patients for psychotherapy, given options for both Integrative Behavioral Health and General Psychiatry referrals. In the outpatient psychiatry setting, psychiatry resident physicians rotating at Outpatient Psychiatric Services at Hillcrest (OPS-H), likewise place psychotherapy referrals often to find that barriers occur regarding patients not being successfully contacted, and therefore not receiving psychotherapy in a timely manner. Historically, there has been little transparency between the administrative staff and providers or patients regarding what happens after a Psychotherapy Consult is placed. This lack of communication can result in confusion, dissatisfaction, and delay in care.

Description of the Project: This project seeks to evaluate the logistics of placing the psychotherapy consult, by surveying providers in both primary care and psychiatry, and interviewing outpatient clinic managers to obtain detailed information regarding the referral processing system. More specifically, the project will survey Family Medicine providers to assess their level of understanding of referral avenues within primary care, in order to connect patients with most appropriate psychiatric resources. The project will also survey Psychiatry providers to assess their concerns regarding psychotherapy, including time for referrals to be approved, modalities utilized by staff to contact patients for scheduling, ability for patients to schedule with a therapist who speaks their preferred language, and communication between the administrative staff and providers when a referral is being closed. 

Lessons Learned/Expected Outcomes: The aims of this project are to utilize these results to: - Provide educational tools for primary care providers to navigate the psychiatry referrals system - Improve communication between the psychiatry administrative staff and providers regarding internal therapy referrals and possible barriers that may inhibit patients receiving this care - Discuss with psychiatry/psychology leadership about potential improvements in the referral process to streamline connecting patients with appropriate care 

Recommendations/Next Steps: The aim of this project is to provide primary care and psychiatry providers with clear guidance on how to most effectively connect patients with appropriate psychotherapy services, by creating educational tools such as flowsheets for providers to utilize when placing psychotherapy referrals. The project will also seek to improve patient engagement in their psychotherapy referrals by providing them with anticipated wait times and contact information they may use to follow up on their referral if they are not contacted in a timely manner.Once these are successfully accomplished, we anticipate replicating this process for the inpatient setting to focus on educating providers on both the inpatient and outpatient psychotherapy service options to promote improving patient access to mental health services.