Parents' Awareness of Bullying Involvement in Relation to Physician Practices: Implications for Practice Modifications

Background Bullying is a complex abusive behavior with potentially serious consequences. Persons who bully and those who are bullied have consistently been found to have higher levels of depression, suicidal ideation, physical injury, distractibility, somatic problems, anxiety, poor self-esteem, and school absenteeism than those not involved with bullying. Objectives To our knowledge, no study has compared physicians' practices of bullying prevention across different hospital settings and the effect of these practices on parents' level of awareness. This article represents a subset (phase I) of the inter-departmental quality improvement study for comparing practices of healthcare professionals regarding bullying prevention between the pediatric outpatient clinic and child & adolescent psychiatry outpatient clinic, and parents' awareness about provider's anti-bullying practices. Methods Phase I was conducted as a cross-sectional study with the target population of adolescents (age 12-17 yrs) and corresponding guardians, seeking care from healthcare providers (residents, fellows and attendings) in the child & adolescent outpatient psychiatry clinic and pediatric outpatient clinic. It targeted both patients and providers, with adolescents/guardians completing questionnaire about bullying experiences, physician's anti-bullying practices during past healthcare visits and adolescent Peer Relations Instrument. Providers answered questions about bullying assessing practices, level of self-preparedness and limitations. Results Data were analyzed in SAS 9.2 (SAS Institute Inc., Cary, NC) and SPSS (IBM Corp., Armonk, NY) and Chi-square tests were used for analyses of variables, and cross-comparing results for particular subsets. A total of 150 questionnaires were distributed. Among the provider surveys, self-reported level of preparedness (on a scale of 1-5; 1- least, 5-most) for assessing bullying was more in Psychiatry providers (Median 4, Mean 4.1) as compared to Pediatric providers (Median 3, Mean 2.9). In the first evaluation, very unprepared, unprepared and neutral (1, 2, 3) responses were contrasted with prepared to very prepared responses (4,5). The second evaluation excludes the neutral responses (3) and tests responses for the unprepared group (1,2) with the prepared group (4,5). The first evaluation resulted in Chi-Squared = 6.810, significant at p = 0.05 and the second evaluation resulted in Chi-squared = 4.774, also significant at p = 0.05. Conclusions This study identifies differences in healthcare professional's anti-bullying practices and helps in identifying limiting factors. This identification of the practice gap helps in developing interventional strategies to improve the assessment of bullying situations across specialties.

An Audit of Inpatient Consultation-Liaison Psychiatry Services at an Inner New York City Safety Net Hospital

Background Our study's primary objective is to audit the resource utilization of a consultation-liaison (CL) psychiatry service in an inner New York City safety net hospital. This cross-sectional, observational study was conducted as a subset of a quality improvement project at the hospital to investigate the characteristics of the emergent nature of consults, types, and the specialty from which the referral was placed to the CL services. This study aims to improve the efficacy of our consult process by improving the appropriateness and precision of consult requests. Methodology This cross-sectional, observational study was reviewed and approved by the Institutional Review Board under a quality improvement exemption. The study investigated the EPIC electronic medical record data for characteristics of consult referrals in the third quarter of 2019 from July 1, 2019, to September 30, 2019. A total of 629 consults were recorded during this period. We excluded follow-up calls, duplicate data rows, and patients with missing data points; the final consults were 421. Patients who required more than one new consult (follow-up excluded) within 90 days were considered; thus, the total number of patients who were included in the study was 327. Results Of the 421 consults identified in the dataset for review, only 45.8% were valid consults, 32.8% were not valid, and 21.4% were uncertain. Further, the most common department from which consults were placed was Medicine (73.2%), followed by Surgery (12.8%), Obstetrics/Gynecology (9%), Critical Care (3.6%), and, finally, Pediatrics (1.4%). Conclusions The study overviews the quality of general consults for the CL psychiatry service and how the CL staff manages it. It also provides an idea about the number of consults that can be comprehensively addressed.