Integral patient care: mental health in a critical patient service

Mental healthcare in hospital wards for critical patients is necessary both for individuals with psychological or psychiatric disorders that require intensive medical care and for those individuals who develop these disorders during hospitalization, often in the same function, illness or treatment. These disorders may cause negative impact on adherence to clinical care, well-being, psychosocial rehabilitation and patient safety during hospitalization. In our department there is a psychologist working in conjunction as part of the healthcare team, aiming to identify psychological risk factors that may impact on treatment and help the team in handling difficult situations psychologically. To identify patients with psychiatric risk, we developed a protocol for Psychiatric Risk Assessment, whereby the presence of 11 items identified by the nurse initiates the discussion of a case with a psychiatrist at the Center for Psychosomatic Medicine of Hospital Israelita Albert Einstein, which directs care and/or suggests mental health interventions. Driving this protocol is the need to ask the nurse to discuss with the mental health professional based on the identification and recovery of behavioral changes that may be missed and/or be identified only when there is already an exacerbation of psychiatric conditions or occurrences related to them. Aiming to assist the nursing staff on early identification of these risks and organize actions during the stay in the ward and at discharge, a multidisciplinary meeting weekly was implemented to discuss cases and situations related to them.