Guardianship Consultations in the Psychiatric Consultation Service in a General Hospital [PW10-05]

Abstract

Objective:

Due to the implementation of the DRGs (Diagnosis Related Groups) in the somatic departments of general hospitals, an elevated demand for psychiatric consultations can be anticipated. It is a moot question whether psychiatric consultation services are adequate for such a surplus load. We investigated whether the proportion of psychiatric consultation requests for patient's capacity to consent and for guardianship is rising.

Method:

The DRGs were implemented in the somatic departments of the Ev. Krankenhaus Königin Elisabeth Herzberge (KEH) at the end of 2003. We compared consultation requests with the keywords “capacity to consent”, “capacity to enter contracts” and “need for guardianship” in the year 2002 with 2004.

Results:

Significantly more consultations with the keyword “guardianship” were requested in 2004 compared to 2002 (p=0.019). 56% concerned medical questions regarding capacity of consent. There was a slight, but increase in the requests social reasons.

The confirmation of the indication for the appointment of a guardian decreased inversely without statistical significance (80% in 2002 and 64% in 2004; Chi-Square p=0.058).

Conclusion:

The increasing demand of the consiliary-liason-service was confirmed in our investigation. It is possible that the implementation of the DRGs plays a role in the increase of psychiatric consultation request. As a trial to ease the growing burden, we developed a form which also enables colleagues from the somatic departments to apply for guardianship of their patients without psychiatric assistance.