Inpatient Internal Medicine and Psychiatry Unit

Pick an acute psychiatric disease. Now pick a severe medical disease. Now put them in the same patient. You may just have described a patient who is an appropriate patient for our inpatient unit, a resource for treating patients with an acute problem in both the psychiatric and medical domains. Herein lies the excitement in working in this interesting and invigorating environment. Any combination of problems can be seen and treated here. This unit serves the hospital and the community by specializing in the treatment of delirium, and substance intoxication and withdrawal syndromes, but also can manage patients/problems such as (to name just a few examples):

Psychiatric syndromes associated with hyponatremia

Schizophrenia with gastrointestinal bleeding

Suicide attempt victims with severe body and head injuries

Hyperthyroidism with bipolar disorder

Anorexia nervosa, with metabolic derangements, and/or congestive heart failure

Mental retardation/agitation in patient who has swallowed a pencil or razor blade

Serotonin syndrome

Neuroleptic malignant syndrome

Catatonia

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Attending Physicians:

• Dually trained Faculty
  OR
• Team of 2 Co-attending Physicians –one Internist and one Psychiatris

Resident Team:

• 1 Senior Resident (Internal Medicine or Med-Psych)
• 2 Interns- One from Internal Medicine, One from Psychiatry

Nursing Staff:

This is one of the key elements. All nurses on this unit have training in medical and psychiatric nursing and are equipped to deal with both sets of problems.

Nursing Perspective: Medical Psychiatry – Excellent Service
The Medical Psychiatry Unit (4SE) is recognized as a unique state resource and a national leader in providing healthcare based on a model that fully integrates medical and psychiatric care. Patients are served with concurrent attention to both their medical and psychiatric needs in a secure setting with specially trained staff.

The special features of the unit include a nursing staff knowledgeable in both general medicine and psychiatry and physicians who have training in Internal Medicine and/or Psychiatry. Dually-certified physicians attend on the unit 9 months of the year. This assures that the medical and psychiatric aspects are assessed appropriately and that the interaction between the two can be included as decisions are made regarding care.

Another key feature of care is the multidisciplinary nature of the assessment and treatment for patients. Physical therapy, Occupational Therapy, Activities Therapy and Social work services are provided, as indicated. Each patient’s care is discussed daily in rounds by the physician, nurse and social worker. In addition, multidisciplinary rounds occur, including all of the therapists at least weekly for each patient.

In addition to providing excellent service to patients, the 4SE team provides a unique service to other hospitals. As one of the first, and still one of the few such units in the country, 4SE staff are well-positioned to help other organizations create combined units or improve their care of medical psychiatry patients. Our nurses, including Marcia Gingerich, nurse manager of 4SE, have provided leadership in developing a consultation service. She, along with other members of the treatment team, has assisted many others via phone and e-mail conferencing. In addition, multidisciplinary care provider teams and administrators from the following hospitals have come to 4SE for full day consultations in the past year:

• Mayo Clinic, Rochester, Minnesota – 9/15/06
• Cooper University Hospital, Camden, New Jersey – 11/7/06
• University of Minnesota, Minneapolis, Minnesota - 1/24/07
• North Memorial Hospital, Robbinsdale, Minnesota – 5/8/07
• Horizon Health Behavioral Health Services, Lewisville, Texas – 6/11-12/07

During these consultative visits, the group meets with a multidisciplinary team to learn about admissions, patient care challenges, legal issues, discharge planning, administrative and reimbursement issues, other financial aspects, nursing education, common diagnoses, therapies and various levels of care.

In summary, body and mind cannot be separated, and through the integration of behavioral and physical care, an excellent service is provided to patients on 4SE. Additionally, the 4SE multidisciplinary staff is a service to other organizations (and their patients) through their consultation work.

Social Work

• Schael Engel

Additional Services:

• Activities Therapy
• Physical Therapy
• Occupational therapy
• Coping Skills training

One of the key elements of the MPU which allows it to provide such excellent care, is the multidisciplinary nature. All appropriate patients are seen by therapists from physical, occupational and activities therapy. All patients are discussed in a weekly multidisciplinary meeting attended by representatives from all services.

Over the course of the residency, each trainee spends 3-5 months on this unit evaluating and treating patients with combined illness. Not only do they develop the skills to treat the illness in each discipline, they also develop an understanding of the complex disease relationships occurring in these patients.