P-47: From guideline to bedside: implementing inpatient pediatric psychology consultation at the time of type 1 diabetes diagnosis
K Dimentstein, R WolfAbstract
Introduction
ISPAD guidelines recommend psychosocial assessment and support at the time of T1D diagnosis. In 2018, the Johns Hopkins Pediatric Diabetes Center implemented a program recommending inpatient psychology consultation for all youth with new onset T1D.
Objectives
Describe implementation outcomes and barriers.
Methods
Retrospective descriptive analyses were conducted for new-onset T1D admissions in 2024-2025. Outcomes included completion of inpatient psychology consultation, referral to and completion of post-discharge telehealth consultation, declination of services, discharge prior to consultation, lack of consultation during admission, and insurance-related barriers.
Results
In 2024, 89 patients were admitted. Of these, 29/89 (33%) were seen by psychology during admission. Telehealth consultation was requested by 13/89 families (15%), with 5/13 (39%) completing follow-up. Twelve families (14%) declined services, 14/89 (16%) were discharged prior to consultation, and psychology was not consulted by the medical team during admission in 11/89 (12%) cases. Insurance barriers were cited in three cases (3%). In 2025, 91 patients were admitted and 37/91 (41%) received inpatient psychology consultation. Telehealth consultation was requested by 21/91 families (23%), with 9/21 (43%) completing visits. Nine families (10%) declined services, 8 (9%) were discharged prior to consultation, and 9 (10%) were not consulted. Insurance barriers were identified in four cases (4.4%). During both years, many missed patients were seen subsequently at routine outpatient diabetes clinic visits.
Conclusions
Inpatient psychology consultation and telehealth referrals increased from 2024 to 2025; however, fewer than half of referred families completed consultation in-person or via telehealth. System-level optimization, including targeted workflow improvements, standardized consent processes, and improved engagement strategies are needed to better align practice with ISPAD recommendations for integrated psychosocial care at diagnosis.