Urgent psychiatric referrals in the general hospital: Unscheduled consultations in a biopsychosocial perspective.

BACKGROUND: Few studies have compared urgent and routine psychiatric consultations in General Hospitals (GHs), particularly regarding clinical outcomes and social vulnerability. This study aimed to characterize urgent referrals, identify clinical and social predictors, and examine associations with length of stay (LOS) and discharge outcomes. MATERIALS AND METHODS: We conducted an 18-month cross-sectional multicenter study across nine Italian GHs, classifying inpatient psychiatric referrals as urgent or routine based on timing and clinical acuity. Data were collected using a standardized Patient Registration Form. Social and family difficulties were assessed in a subsample using the Canadian Problem Checklist (PCL), with PCLs+ indicating at least one social problem. Analyses included bivariate tests, mixed-effects logistic regression with center as a random effect, and Kaplan-Meier survival analysis for LOS. RESULTS: Among 3919 referrals, 680 (17.35%) were urgent. Compared with routine referrals, urgent patients were younger (55.5 ± 19.7 vs 61.9 ± 17.2 years, p < 0.01), more frequently single (29.9% vs 21.7%, p < 0.01) or unemployed (18.5% vs 11.9%, p < 0.01), and more often admitted from surgical wards (30.5% vs 18.7%, p < 0.01) or intensive care units (6.9% vs 2.7%, p < 0.01). Independent predictors of urgent referral were neuropsychiatric syndromes (OR = 3.64, p < 0.01), surgical admission (OR = 1.79, p < 0.05), suicide attempt or risk (OR = 6.96, p < 0.01), and PCLs+ status (OR = 1.37, p < 0.05). Urgent consultations were associated with shorter LOS (15.4 ± 23.7 vs 21.1 ± 31.0 days, p < 0.01). Kaplan-Meier analysis showed the shortest LOS in PCLs+/urgent patients and the longest in PCLs-/routine patients (p < 0.001). Urgent referrals more frequently resulted in psychiatric admission (9.8% vs 2.1%, p < 0.001) and referral to community mental health services (24.8% vs 20.5%, p < 0.001). CONCLUSIONS: Urgent psychiatric consultations in GHs are associated with complex clinical presentations and social vulnerability. Early CLP involvement may contribute to improved clinical management and post-discharge care pathways, although its potential impact on LOS should be interpreted with caution. These findings support the integration of social factors into psychiatric emergency assessment.