CUH Liaison Psychiatry Service



What is Liaison Psychiatry?

Liaison Psychiatry is the branch of psychiatry that deals with the mental health of patients presenting in the general hospital setting. Common presentations include deliberate self-harm (DSH) , physical and psychiatric co-morbidity, medically unexplained physical symptoms, organic brain syndromes and behavioural disturbance.

Referrals

  • A clear simple referral pathway is in place to facilitate further assessment of patients with mental health problems in the ED
  • Adult patients in ED presenting with mental health problems (including self-harm) are assessed by a member of the Liaison Psychiatry team or by the on-call Psychiatry NCHD following referral by the EM clinician.
  • Sometimes because of necessary medical treatment, the mental health assessment may be deferred until the patient is fit to be interviewed. This does not necessarily preclude the ED staff liaising with the mental health staff about aspects of the patient’s management in the interim.

How to make a Referral

Monday– Friday 8-4pm

  • Discuss face-face with the Liaison Psychiatry Team in the ED each morning at 8am.
  • Contact the Liaison Psychiatry Team (Self-Harm ‘Crisis’ CNS Tel: VPN 65327/65324; Alcohol & Drug Liaison CNS Tel: VPN 61184: Liaison Doctor Tel: VPN 62409/62410).

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Out of Hours & Weekends

  • Contact the Psychiatry Registrar-on-Call (Tel: VPN 67103)
  • Self-Harm on Saturday and Sunday 8-4pm, contact the Self-Harm ‘Crisis’ CNS Tel: VPN 65327/65324

Psychiatry Response to a Referral

  • The mental health service will in general prioritise for assessment patients with mental health problems in the ED over those presenting elsewhere in CUH.
  • Urgent referrals will be responded to by telephone discussion in the first instance. This will be followed by an assessment on the same day, the timing and priority of which will depend on the level of urgency and on the day’s workload.
  • The outcome of the assessment by the mental health professional will be:
    • recorded in the ED notes using a standardised assessment form
    • discussed verbally with the ED staff
    • discussed with the patient and/carer
    • communicated to the patients GP
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Our relationship with the 'Crisis Nurses'?

  • Crisis nurses were appointed as part of a range of measures for suicide prevention strategy
  • They provide assessment and follow-up of new patients with self-harm attending the EDs of Cork city
  • The CUH Liaison Psychiatry service operates independently of the crisis nursing service

GF Unit

  • GF Unit is the acute inpatient psychiatric unit serving the catchment area of South Lee
    • Bandon/Kinsale, Douglas/Carraigaline, Ballincollig, Bishopstown, Togher/Ballyphehan and Blackrock/Mahon
  • GF is an unlocked ward and is not suitable for medically ill patients
  • The Liaison Psychiatry Service does not have access to designated inpatient beds
  • The Liaison Psychiatry Service will assist in the transfer of ED patients requiring psychiatric admission to their appropriate inpatient psychiatric unit as well as in their management in the ED while pending transfer.
  • Patients will not be accommodated in GF Unit while they are pending transfer
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CUH Plastic Surgery service from other hospitals/services following DSH

All patients who have had deliberate self-harm should have a psychosocial assessment by a trained assessor as early as possible following the episode. In most centres this assessor will be the psychiatrist on-call to the local ED.

Prior to accepting a referral of a patient following deliberate self-harm to CUH for a plastic surgery assessment/intervention, the surgical team should ensure the following:

  1. The patient has had a psychosocial / risk assessment by the local psychiatrist on-call.
  2. The outcome of this assessment has included inter alia clear recommendations:
    • supervision arrangements and contingency planning during transport to CUH
    • the need for special (1:1) nursing during the CUH inpatient/outpatient stay
    • the level of urgency of the need for further psychiatric assessment in CUH
  3. A written copy / summary of the psychosocial assessment is included with the surgical transfer letter that accompanies the patient to CUH.

Procedure for Discharge of Inpatients

Some patients may require psychiatric admission / close psychiatric follow-up following discharge from CUH Plastics inpatient treatment. Such patients may not, for example, be suitable for transfer to SMOH for Physio/rehab because of their mental state and associated risks.

Therefore please contact CUH Liaison Psychiatry service well before discharge so that appropriate aftercare can be arranged.


Links

MSWord copy agreed Management plastic surgery patients with DSH


Contents by Dr Eugene Cassidy, Dr Íomhar O' Sullivan 26/11/03. Approved by Clinical Policy Group 26/11/03.  Reviewed 26/11/04, 06/09/2005, 14/12/2007. Last review Dr ÍOS 8/09/14.