Citation

Campbell ST, Schultz BJ, Franciscus AM, Ravindranath D, Bishop JA. Curr. Orthop. Pract. 2018; 29(3): 270-274.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/BCO.0000000000000619

PMID

unavailable

Abstract

BACKGROUND: The burden of psychologic stressors among trauma patients is high, and these symptoms are often left untreated. The purpose of this study was to determine the threshold for psychiatric symptom severity for which the orthopaedic surgeon and psychiatrist believe a consultation is indicated, and to compare these thresholds between the two groups.

METHODS: A survey was created following multidisciplinary discussion, which consisted of ten clinical scenarios related to orthopaedic trauma patients with symptoms of common psychologic stressors. The survey was distributed to residents in the orthopaedic surgery and psychiatry programs at our institution. Participants were asked whether a psychiatry consultation was indicated. Nonparametric statistics were used to analyze differences. Qualitative data were obtained from participants to better understand trends.

RESULTS: The survey was completed by 32 trainees (82 possible, 39%). There was agreement between the groups regarding scenarios involving suicidality, drug use or withdrawal, and the capacity to consent. There was disagreement for clinical scenarios involving schizophrenia, with orthopaedic surgeons believing a psychiatry consultation was indicated significantly more often than psychiatrists, and delirium, in which orthopaedic surgeons thought that a psychiatry consultation was indicated significantly less often than psychiatrists.

CONCLUSIONS: This study demonstrated disagreement between orthopaedic surgery and psychiatry trainees. Psychiatry residents may believe that some inpatient consults for psychotic patients are unnecessary, while orthopaedic residents may be under-utilizing resources for delirious patients. Further study is necessary to determine if these trends exist at the national level and if there are implications for patient outcomes. © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Language: en

Keywords

human; suicide; injury; pilot study; psychiatry; schizophrenia; drug use; disease severity; comparative study; mental disease; psychological aspect; mental health care; neuroleptic agent; psychiatrist; voice; consultation; clinical article; priority journal; hallucination; drug withdrawal; geriatric patient; sleep waking cycle; auditory hallucination; Article; nonparametric test; resident; orthopedic surgery; hearing; orthopedic surgeon; femoral neck fracture; hip replacement; interdisciplinary care; orthopedic specialist; psychiatry consultation; psychologic aspects of disease