What to Know About Our Inpatient & Emergency Department Care

Shamim Nejad, MD, joined Valley in December 2020 to head up the Consultation Psychiatry Service. Since he has been here, many staff members and provider colleagues have commented on the excellent work he has done to improve the inpatient and emergency psychiatric care for our patients. We interviewed Dr. Nejad to learn more about his program, patients they treat, and address misconceptions about the scope of care they provide.

The Consultation Psychiatry Service providers are Shamim Nejad, MD and Lee Vivanco, ARNP

What is the Consultation Psychiatry Service here at Valley?

Valley’s inpatient psychiatry service operates on a consultation-basis, providing a broad range of services. Consultation psychiatry specializes in providing care for patients who have an underlying psychiatric illness, including things like substance use, as well as a comorbid medical, surgical, or neurologic illness. We are specially trained to work with patients who are suffering from a combination of mental and physical illness through comprehensive patient assessment and working closely with other members of the patient’s healthcare team.

At Valley, our team manages patients in the emergency department and inpatient units. This is unique, compared to many other institutions who have separate psychiatric teams; covering both areas helps patients get the care they need in a timely manner. Our team’s responsibility is to be proactive and deliver care as early as possible so we can try to stabilize these patients and get them better, so they can get to the next stage of care.

What types of patients are treated by the Consultation Psychiatry Service?

In the emergency department, our team treats two main types of patients: those under the involuntary treatment act, awaiting an inpatient psychiatric bed and those boarding in the emergency room or on a medical unit who require stabilization and treatment before their transfer to another facility.

Throughout our inpatient departments, our team treats patients on the medical, surgical, and intensive care units, as well as some specialty areas. Their patient population includes, but is not limited to:

• Patients with acute confusion, secondary to an acute medical, surgical, or neurologic condition with resulting neuropsychiatric, neurobehavioral, and/or neurocognitive sequela. (e.g., altered mental status, delirium management, etc.)
• Patients with medical-surgical etiologies, but have acute or subacute psychiatric conditions, like depression and anxiety
• Patients with symptoms of post-traumatic stress that may be affecting the delivery of their medical care
• Patients with comorbid alcohol, opiate, methamphetamine, and substance use disorders
• Patients with an acute manifestation or neuropsychiatric or neurocognitive disorders that occur as a result of a medical condition. (e.g., post-stroke, anoxic brain injuries, etc.)
• Patients with underlying neurodegenerative processes (e.g., Alzheimer’s, Parkinson’s, mixed-type dementia, etc.) resulting in some form of neurobehavioral manifestation that affects the delivery of medical care or their ability to transition to the next level of care
• Patients in psychiatric oncology
• Patients in the intensive care unit who may be agitated or require help with the successful weaning off mechanical ventilation
• Patients with seizure disorders and other neuropsychiatric sequela

When treating this wide array of patients, the consultation psychiatry team primarily focuses on what caused the patient’s symptoms and how to best manage them. This better optimizes care and more adequately prepares them for the rehabilitative stages of recovery, allowing patients to achieve their best outcomes.

What type of training does a consultation psychiatrist have?

To be certified as a consultation psychiatrist, providers must participate in a 12-month fellowship program that has been certified through the Accreditation Council for Graduate Medical Education. These programs include specialty training that cover topics such as the delivery of care within the general hospital setting and how to optimize efficiency in clinical care and patient outcomes.

What developments and progress has the Consultation Psychiatry Service experienced since you have been at VMC?

Since I started, we’ve been able to optimize the efficiency of consultations, increase the breadth of interventions we offer, improve the protocols for our patients with alcohol withdrawal, and better-formalize our evaluation process for patients with substance use disorder, just to name a few.

These advances have allowed us to improve patient outcomes, reduce ICU admissions or reduce the overall length of stay in the ICU, decrease adverse outcomes related to illness, and prevent re-admissions. These improvements also lessen the burden to our nursing staff by reducing the instances of acute agitation that may result in a combative or assaultive patient, as well as decreasing the use of patient restraints over time. Currently, we are working on formalizing a process for delirium recognition, prevention, and management.

What is a common misunderstanding about what your team does?

Many people believe we only see patients with pre-existing psychiatric problems or a diagnosis, but we don’t. Most of the patients we see are medical or surgical patients with acute and unexplained psychiatric symptoms.

We evaluate the patient to help figure out what is causing their symptoms and provide recommendations and interventions until the patient has stabilized and those acute symptoms are managed. Many providers don’t realize they can use our services for these cases, but the more we’re utilized, the better we’ll be able to improve and hone the interventions we provide, which will only continue to benefit our patients and staff.

Here are some quotes from VMC providers commending Dr. Nejad:

“Dr. Nejad strives to make the inpatient psychiatry services easily accessible. He is collaborative and approachable, always seeking to understand how he can best assist our providers in patient care.”

“Dr. Nejad is exemplary in closing the loop on communication. He directly communicates his recommendations with the treatment team. His documentation is thorough and comprehensive, reinforcing his communicated recommendations and plan.”

“He has also made himself available and integral to the care of our vulnerable patients by extending his services to bridge gaps in the transition of care for patients with opioid use disorder .”

“I am impressed with Dr Nejad’s commitment to our ED Behavioral health patients. He proactively supports the care of these patients and has made several workflow improvements to address certain gaps and improve quality.”

“Dr. Nejad has provided improved consistency and reliability for our hospital-based psychiatry consult service.”