"Having that psychiatric background is important," Triplett says. "They are able to walk into room and do a psychiatric assessment—to some degree."
The real influence, though, comes from the nurse practitioner.
That was a tip Triplett says he received from Hochang "Ben" Lee, MD, founding director of Yale-New Haven Hospital's Psychological Medicine Research Center psychological.
Lee is a former faculty member at Johns Hopkins Hospital, and co-authored a study showing that a proactive psychiatric consult approach reduced patients' length of stay.
"We're finding that the nurse practitioners having conversations with floor nurses and nurse managers is where the power of the program seems to lie," says Triplett.
"Nurses see the value of it because they really do manage the setting."
BIT in Action
When a patient is admitted, the BIT members swing into action. Patients are screened for active and dormant psychiatric issues, classified into three tiers, and triaged accordingly:
- Tier 1: Patients who have debilitating psychiatric symptoms.
- Tier 2: Patients with a wide-ranging spectrum of acuity.
- Tier 3: Patients with the lowest risk of psychiatric illness interfering with the primary medical diagnosis.
A tiered triage system helps the BIT members know when and how often to confer with the medical team taking care of the patient.
BIT members help with medication management, communication and coordinating care with the hospital's substance abuse services, if needed.
Regardless of how patients are triaged, Triplett says the BIT members consult with the medical team before seeing the patient.
"Context matters," Triplett says. "After we talk to the medical team, we may walk in and say, 'We're from psychiatry, how do you feel your bipolar disorder is being handled?' Sometimes patients do not want someone from psychiatry in their room, and sometimes you pick up things that might not appear in the chart."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.