The Bed Requirement Inventory: A Simple Measure To Estimate The Need For A Psychiatric Bed

Abstract

Objective: To develop an assessment of bed need that was as little affected by personal biasas possible. Method: The Bed Requirement Inventory (BRI) is an eight-point scale designed to identify the appropriate use of an acute psychiatric bed. This is completed by a member of the ward staff, usually a nurse, and takes 5 minutes to fill in. The reliability, validity and feasibility of using the scale in normal practice were tested in a one-year study, and variations ininappropriate bed use described. Results: The inter-rater reliability of the scale was good (intra-class correlation coefficient = 0.63) and a comparison of the need for a psychiatric bed (comparing the BRI score with the judgement of an independent multidisciplinary group of professionals) also showed good agreement (k ¹/4 0.69), suggesting reasonable validity (although when the assessment was made by the named nurse agreement was less good). Results from a year-long survey in two West London hospitals showed that 17% of admissions were inappropriate and 32% had delayed discharge, black Caribbean patients had a significantly higher proportion (25%) of inappropriate admission than others (11%) and those referred from housing charities andhostels had a higher proportion (50%) of inappropriate bed use at some time than other groups(33%). Conclusions: The Bed Requirement Inventory is a quick and reliable method of determiningthe appropriate use of a psychiatric bed and could be of use in estimating local bed needs. Delayeddischarge remains a serious reason for inappropriate bed use in London.

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References

ALLARDYCE, J. , GILMOUR, H. , ATKINSON, J. , RAPSON, T. , BISHOP, J. & McCREADIE, R.G. (2005) Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses . British Journal of Psychiatry, 187, 401–406 .

BHUI, K. , STANSFELD, S. , HULL, S. , PRIEBE, S. , MOLE, F. & FEDER, G. (2003) Ethnic variations in pathways to and use of specialist mental health services in the UK: systematic review . British Journal of Psychiatry, 182, 105–116 .

CARR-HILL, R.A. , SHELDON, T.A. , SMITH, P. , MARTIN, S. , PEACOCK, S. & HARDMAN, G. (1994) Allocating resources to health authorities: development of method for small area analysis ofuse of inpatient services . BMJ, 309, 1046–1049 .

CHISHOLM, D. , KNAPP, M.R. , ASTIN, J. , LELLIOTT, P. & AUDINI, B. (1997) The mental health residential care study: predicting costs from resident characteristics . British Journal of Psychiatry, 170, 37–42 .

CICCHETTI, D. V. , HEAVENS, R. , DIDRIKSEN, J. & SHOWALTER, D. (1984) A computer program for assessing the reliability of nominal scales using varying sets of multiple raters . Educational and Psychological Measurement, 44, 671–675 .

CICCHETTI, D.V. (2001) The precision of reliability and validity estimates re-visited: distinguishing between clinical and statistical significance of sample size requirements . (Methodological Commentary). Journal of Clinical and Experimental Neuropsychology,23, 695–700 .

FITZPATRICK, N.K. , THOMPSON, C.J. , HEMINGWAY, H. , BARNES, T.R.E. , HIGGITT, A. , MOLLOY, C. & HARGREAVES, S. (2003) Acute mental health admissions in inner London: changes in patientcharacteristics and clinical admission thresholds between 1988 and 1998 . Psychiatric Bulletin,27, 7–11 .

FLANNIGAN, C.B. , GLOVER, G.R. , FEENEY, S.T. , WING, J.K. , BEBBINGTON, P.E. & LEWIS, S.W. (1994) Inner London collaborative audit of admissions in two health districts. I: Introduction, methods and preliminary findings . British Journal of Psychiatry, 165, 734–742 .

FULOP, N. , KOFFMAN, J. & HUDSON, M. (1992) Challenging bed behaviours: the use of acute psychiatric beds in an inner London District Health Authority . Journal of Mental Health, 1, 335–341 .

10.

FULOP, N.J. , KOFFMAN, J. , CARSON, S. , ROBINSON, A. , PASHLEY, D. & COLEMAN, K. (1996) Use of acute psychiatric beds: a point prevalence survey in North and South Thames regions . Journal of Public Health Medicine, 18, 207–216 .

11.

GLOVER, G. , FARMER, R. & PRESTON, D. (1990) Indicators of mental hospital bed use . Health Trends,22, 111–115 .

12.

GLOVER, G. , ARTS, G. & WOOFF, D. (2004) A needs index for mental health care in England based on updatable data . Social Psychiatry and Psychiatric Epidemiology, 39, 730–738 .

13.

GOLDBERG, D. & HUXLEY, P. (1992) Common Mental Disorders: A Biosocial Model. London: Tavistock/Routledge .

14.

JARMAN, B. (1983) Identification of underprivileged areas .British Medical Journal, 286, 1705–1709 .

15.

JOHNSTONE, P. & ZOLESE, G. (1999) Systematic review of the effectiveness of planned short hospital stays for mental health care . British Medical Journal, 318, 1387–1390 .

16.

KNAPP, M. , BEECHAM, J. , ANDERSON, J. , DAYSON, D. , LEFF, J. , MARGOLIUS, O. , O'DRISCOLL, C. & WILLSET, W. (1990) The TAPS project. 3: predicting the community costs of closing psychiatric hospitals . British Journal of Psychiatry, 157, 661–670 .

17.

KNAPP, M. , KING, D. , PUGNER, K. & LAPUERTA, P. (2004) Non-adherence to antipsychotic medication regimens: associations with resource use and costs . British Journal of Psychiatry, 184, 509–516 .

18.

LAMONT, A. , UKOUMUNNE, O. , TYRER, P. , THORNICROFT, G. , PATEL, R. & SLAUGHTER, J. (2000) The geographic mobility of severely mentally ill residents in London . Social Psychiatry and Psychiatric Epidemiology, 35, 164–169 .

19.

LELLIOTT, P. , AUDINI, B. , KNAPP, M. & CHISHOLM, D. (1996) The mental health residential care study: classiffication of facilities and description of residents . British Journal of Psychiatry, 169, 139–147 .

20.

MERSON, S. , TYRER, P. , CARLEN, D. & JOHNSON, A.L. (1996) The cost of treatment of psychiatric emergencies: a comparison of hospital and community services . Psychological Medicine, 26, 727–734 .

21.

MILMIS PROJECT GROUP (1995). Monitoring inner London mental illness services . Psychiatric Bulletin, 19, 276–280 .

22.

MORGAN, C. , MALLETT, R. , HUTCHINSON, G. , BAGALKOTE, H. , MORGAN, K. , FEARON, P. , DAZZAN, P. , BOYDELL, J. , McKENZIE, K. , HARRISON, G. , MURRAY, R. , JONES, P. , CRAIG, Y. & LEFF, J. (on behalf of the ÆSOP Study Group) (2005) Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission: Report from the ÆSOP study . British Journal of Psychiatry, 186, 281–289 .

23.

NORTON, K. (2004) Re-thinking acute psychiatric inpatient care . International Journal of SocialPsychiatry, 50, 274–284 .

24.

RUTTER, D. , TYRER, P. , EMMANUEL, J. , WEAVER, T. , BYFORD, S. , HALLAM, A. , SIMMONDS, S. & FERGUSON, B. (2004) Internal versus external care management in severe mental illness: randomised controlled trial and qualitative study . Journal of Mental Health, 13, 453–466 .

25.

SHAH, A.K. & JENKINS, R. (2000) Mental health economic studies from developing countries reviewed in the context of those from developed countries . Acta Psychiatrica Scandinavica, 101, 87–103 .

26.

SMYTH, M.G. & HOULT, J. (2000) The home treatment enigma . British Medical Journal, 320, 305–309 .

27.

THOMPSON, A. , SHAW, M. , HARRISON, G. , HO, D. , GUNNELL, D. & VERNE, J. (2004) Patternsof hospital admission for adult psychiatric illness in England: analysis of hospital episode statistics data . British Journal of Psychiatry, 185, 334–341 .

28.

THORNICROFT, G. & TANSELLA, M. (2004) Components of a modern mental health service: apragmatic balance of community and hospital care: overview of systematic evidence . British Journal of Psychiatry, 185, 283–290 .

29.

TYRER, P. , EVANS, K. , GANDHI, N. , LAMONT, A. , HARRISON-READ, P. & JOHNSON, T. (1998) Randomised controlled trial of two models of care for discharged psychotic patients . British Medical Journal, 316, 106–109 .

30.

TYRER, P. , JONES, V. , THOMPSON, S. , CATALAN, J. , SCHMIDT, U. , DAVIDSON, K. , KNAPP, M. & UKOUMUNNE, O. (on behalf of the POPMACT group) (2003) Service variation in baseline variables and prediction of risk in a randomised controlled trial of psychological treatment in repeated parasuicide: the POPMACT study . International Journal of Social Psychiatry, 49, 58–69 .