Somatic Symptom and Related Disorders (SSRD) Clinical Pathway

Pathway Background and Objectives

Somatic Symptom and Related Disorders (SSRD) is a clinical presentation where symptoms or impairment cannot be fully explained by an identifiable disease process given the current medical evidence. This pathway seeks to evaluate and ultimately explain to patients and their families the cause of these often debilitating symptoms. Given that the care of these patients is often scattered, provider and patient satisfaction historically quite low. This pathway seeks to create a standardized approach and common language for the management of patients presenting with medically unexplained physical symptoms.

Specifically, the objectives of this pathway are to:

Standardize a treatment approach regardless of clinical service or presenting complaint
Standardize, through the use of scripts, the initial approach to these patients and the diagnostic formulation provided to the patient and the family during the informing meeting
Focus the clinical care not just on assessment and determination of diagnosis, but on the promotion of recovery by emphasizing a functional approach rather than promoting the sick role
Ensure that appropriate outpatient services have been set up to promote continued recovery
If a somatic symptom and related disorder (SSRD) is being considered, use the actual DSM-V terminology that is appropriate to the patient’s condition and provide educational material in order to help guide and support the family as needed

Algorithm Educational Module

Quality Metrics

Percentage of patients with use of the SSRD order set
Percentage of patients with documentation of informing meeting
- Percentage of meetings led by primary service
- Percentage of meetings where SSRD diagnosis is shared
- Percentage of meetings where treatment plan is reviewed
- Percentage of meetings where clarification of information is documented
- Percentage of meetings where patient is present
- Percentage of meetings where contact with patient’s PCP is documented
Average length of stay (days)
Average time from admission to informing meeting (hours)
Average time from informing meeting to discharge (hours)
Number of readmissions within 30 days

Key References

Ring A, Dowrick CF, Humphris GM, Davies J, Salmon P. The somatising effect of clinical consultation: What patients and doctors say and do not say when patients present medically unexplained physical symptoms. Soc Sci Med. 2005 Oct;61(7):1505-15.
Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62(8):903-10.
Malas N, Ortiz-Aguayo R, Giles L, Ibeziako P. Pediatric Somatic Symptom Disorders. Curr Psychiatry Rep. 2017 Feb;19(2):11.
Silber TJ, Pao M. Somatization disorders: diagnosis, treatment, and prognosis. Pediatr Rev. 2011 Feb;32(2):56-63.
Van der Leeuw G, Gerrits MJ, Terluin B, Numans ME, van der Feltz-Cornelis CM, van der Horst HE, Penninx BW, van Marwijk. The association between somatization and disability in primary care patients. J Psychosom Res. 2015 Aug;79(2):117-22.

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.