Psychological Consultation Services in the Medical Intensive Care Unit: A Retrospective Observational Study

INTRODUCTION: Critically ill patients and their family members experience profound psychological stress and are at elevated risk for persistent psychiatric sequelae. Despite this, the role of embedded clinical psychologists in the medical intensive care unit (MICU) remains understudied. This study aims to characterize consultation patterns and service utilization of dedicated psychology services across two MICUs and inform future outcomes-focused research. METHODS: This retrospective observational study describes two models of an embedded clinical psychology service within a medical intensive care unit. Psychology consultation data was collected at two large, urban academic medical centers over a one-year period (July 2022-June 2023; N=428). Descriptive statistics and chi-square and independent t-tests were used to characterize and compare sociodemographic, clinical, and consultation variables across sites. RESULTS: Family support was the most common reason for psychology consultation across both sites (Site 1: 40%, Site 2: 28%). Among patient referrals, anxiety, depression, adjustment difficulties, and coping were most frequent. Trauma/stressor-related, depressive, and anxiety disorders were the most common diagnoses; approximately one-third of patients at each site did not receive a formal psychiatric diagnosis. Site 2 patients had significantly longer ICU and hospital lengths of stay and higher rates of ECMO use. Rates of mortality (∼40-43%) and comfort care transitions (∼25-26%) among referred patients were notably elevated at both sites.Other similarities and differences of key sociodemographic, psychological, and medical variables across the two sites are presented and discussed. DISCUSSION: Embedded psychological services were highly utilized for patient and family support in the MICU, particularly in the context of communication barriers, end-of-life care, and high medical complexity. Notably, a substantial proportion of patients who did not meet formal psychiatric diagnostic criteria still presented with clinically significant distress amenable to psychological intervention - a finding with important implications for how psychology services are justified and resourced in critical care settings. Future research should examine associations between embedded psychology consultation and ICU outcomes, including length of stay, delirium incidence and duration, post-ICU psychiatric distress, and family member wellbeing.