To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds.
Methods:
This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed.
Results:
A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%).
Conclusions:
Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients.
ZunLS. Pitfalls in the care of the psychiatric patient in the emergency department. J Emerg Med. 2012;43(5):829–835.
2.
NicksBAMantheyDM. The impact of psychiatric patient boarding in the emergency departments. Emergency medicine international print volume 2012–article ID 360308 [Internet]. New York (NY): Hindawi Publishing Corporation; 2012 [cited 2013 Apr 15]. Available from: http://www.hindawi.com/journals/emi/2012/360308.
3.
TuttleGAL. Report of the Council on Medical Service—access to psychiatric beds and impact on emergency medicine/CMS Report 2-A-08 [Internet]. Chicago (IL): American Medical Association; 2008 [cited 2013 April 15]. Available from: http://www.ama-assn.org/resources/doc/cms/a-08cms2.pdf.
4.
BaraffLJJanoviczNAsarnowJR. Survey of California emergency departments about practices for management of suicidal patients and resources available for their care. Ann Emerg Med. 2006;48(4):452–459.
ShafeiTGaynorNFarrellG.The characteristics, management and outcomes of people identified with mental health issues in an emergency department, Melbourne, Australia. J Psychiatr Ment Health Nurs. 2011;18(1):9–16.
7.
SoodTRMcStayCM. Evaluation of the psychiatric patient. Emerg Med Clin North Am. 2009;27(4):669–683.
8.
HazlettSBMcCarthyMLLondnerMSEpidemiology of adult psychiatric visits to US emergency department. Acad Emerg Med. 2004;11(2):193–195.
9.
SinclairLHunterRHagenSHow effective are mental health nurses in A&E departments?Emerg Med J. 2006;23(9):687–692.
10.
KalucyRThomasLKingD.Changing demand for mental health services in the emergency department of a public hospital. Aust N Z J Psychiatry. 2005;39(1):74–80.
11.
AlakesonVPandeNLudwigM.A plan to reduce emergency room “boarding” of psychiatric patients. Health Affairs. 2010;29(9):1637–1642.
12.
MirinSSummergradP.The evolving academic health center: Challenges and opportunities for psychiatry. Acad Psychiatry. 2011;35(2):89–95.
13.
LambertMTLePageJPSchmittAL. Five-year outcomes following psychiatric consultation to a tertiary care emergency room. Am J Psychiatry. 2003;160(7):1350–1353.
14.
KunenSPrejeanCGladneyBDisposition of emergency department patients with psychiatric comorbidity: Results from the 2004 National Hospital Ambulatory Medical Care Survey. Emerg Med J. 2006;23(4):274–275.
15.
ClaassenCAGilfllanSOrsulakPSubstance use among patients with a psychotic disorder in the psychiatric emergency room. Psychiatr Serv. 1997;48(3):353–358.
McDonaghMSSmithDHGoddardM.Measuring appropriate use of acute beds: Asystematic review of methods and results. Health Policy. 2000;53(3):157–184. Erratum: Health Policy. 2000;54(2):163.
18.
RowlandsP.New long-stay patients on acute psychiatric units: Does audit change practice?Brit J Clin Pract. 1997;51(3):154–156.
19.
PatonJMFahyMALivingstonGA. Delayed discharge—a solvable problem? The place of intermediate care in mental health care of older people. Aging Ment Health. 2004;8(1):34–39.
20.
BeadsmooreAHardyPMooreCRelation between bed use, social deprivation and overall bed availability in acute adult psychiatric units, and alternative residential options: A cross sectional survey, on day census data, and staff interviews. Br Med J. 1997;314(7076):262–266.
21.
McLayRNDayloAHammerPS. Predictors of length of stay in a psychiatric ward service serving active duty military and civilian patient. Mil Med. 2005;170(3):219–222.
22.
JimenezRELamRMMarotMObserved-predicted length of stay for acute psychiatric department, as an indicator of inpatient care inefficiencies—retrospective case-series study. BMC Health Serv Res. 2004;4(1):4–13.
23.
JayaramGTienASullivanPElements of a successful short-stay inpatient psychiatric service. Psychiatr Serv. 1996;47(4):407–412.
24.
BlaisMAMatthewsJLipkis-OrlandoRPredicting length of stay on an acute care medical psychiatric inpatient service. Adm Policy Ment Health. 2003;31(1):15–29.
25.
SloanDMYokleyJGottesmanHA five-year study of the interactive effects of depression and physical illness on psychiatric unit length of stay. Psychosom Med. 1999;61(1):21–25.
26.
PeiroSGomerGNavarroMLength of stay and antipsychotic treatment costs of patients with acute psychosis admitted to hospital in Spain: Description and associated factors—The Psychops Study. Soc Psychiatry Psychiatr Epidemiol. 2004;39(7):507–513.
27.
HuntlyDChoDChristmanJPredicting length of stay in an acute psychiatric hospital. Psychiatr Serv. 1998;49(8):1049–1053.
Canadian Institute for Health Information (CIHI). International Statistical Classification of Diseases and Related Health Problems. 10th revision Canada. Ottawa (ON): CIHI; 2009.
30.
NathSBMarcusSC. Impact of psychotic disorders on discharge dispositions of adults or older after a general medical inpatient stay. Psychiatr Serv. 2012;63(4):333–337.
31.
O'HaraA.Housing for people with mental illness: Update of a report to the President's New Freedom Commission. Psychiatr Serv. 2007;58(7):907–913.
32.
CowanCWalkerP.New long-stay patients in a psychiatric admission ward setting. Psychiatr Bull. 2005;29:452–454.
33.
SaeedHOuellette-KuntzHStuartHLength of stay for psychiatric inpatient services: A comparison of admissions of people with and without developmental disabilities. J Behav Health Serv Res. 2003;30(4):406–417.
34.
ShumwayMAlvidrezJLearyMImpact of capacity reductions in acute public-sector inpatient psychiatric services. Psychiatr Serv. 2012;63(2):135–141.
35.
BartelsSJ. Caring for the whole person: Integrated health care for older adults with severe mental illness and medical comorbidity. J Am Geriatr Soc. 2004;52(Suppl 12):S249–S257.
36.
AschbrennerKGravowskiDCCaiSNursing home admissions and long-stay conversions among persons with and without serious mental illness. J Aging Soc Policy. 2011;23(3):286–304.
37.
SheaDGStreitASmyerMA. Determinants of the use of specialist mental health services by nursing home residents. Health Serv Res. 1994;29(2):169–185.
38.
BeckACroudaceTJSinghSThe Nottingham acute bed study: Alternatives to acute psychiatric care. Br J Psychiatry. 1997;170(3):247–252.
39.
HawthorneWBGreenEEGilmerTA randomized trial of short-term acute residential treatment for veterans. Psychiatr Serv. 2005;56(11):1379–1386.
40.
HawthorneWBGreenEELohrJBComparison of outcomes of acute care in short-term residential treatment and psychiatric hospital settings. Psychiatr Serv. 1999;50(3):401–406.
41.
HawthorneWBGreenEEFolsomDA randomized study comparing the treatment environment in alternative and hospital-based acute psychiatric care. Psychiatr Serv. 2009;60(9):1239–1244.
42.
FentonWSMosherLRHerrellJMRandomized trial of general hospital and residential alternative care for patients with severe and persistent mental illness. Am J Psychiatry. 1998;155(4):516–522.
43.
RiesRKYuodelis-FloresCRoy-ByrnePPAddiction and suicidal behavior in acute psychiatric inpatients. Compr Psychiatry. 2009;50(2):93–99.
44.
SullivanAMBarronCTBezmenJThe safe treatment of the suicidal patient in an adult inpatient setting: A proactive preventive approach. Psychiatr Q. 2005;76(1):67–83.
45.
LarkinGLClaassenCAEmondJATrends in U.S. emergency department visits for mental health conditions, 1992 to 2001. Psychiatr Serv. 2005;56(6):671–677.
46.
WeissAPChangGRauchSLPatient- and practice-related determinants of emergency department length of stay for patients with psychiatric illness. Ann Emerg Med. 2012;60(2):162–171.e5.
47.
LittleDRClasenMEHendricksJLImpact of closure of mental health center: Emergency department utilization and length of stay among patients with severe mental illness. J Health Care Poor Underserved. 2011;22(2):469–472.
48.
SladeEDDixonLBSemmelS.Trends in the duration of emergency department visits, 2001–2006. Psychiatr Serv. 2010;61(9):878–884.
49.
ClarkeDEDusomeDHughesL.Emergency department from the mental health client's perspective. Int J Ment Health Nurs. 2007;16(2):126–131.
50.
SchretlenDJayaramGMakiPDemographic, clinical, and neurocognitive correlates of everyday functional impairment in severe mental illness. J Abnorm Psychol. 2000;109(1):134–138.
51.
GuerreroL LorénGascónCatalánM.Biopsychosocial factors related to length of hospital stay in older people. Rev Lat Am Enfermagem. 2011;19(6):1377–1384.
52.
KozyrskyiADe CosterCSt JohnP.Long stay patients in Winnipeg acute care hospitals. Healthc Manage Forum. 2002;15(Suppl4):15–20.
53.
NilssonARasmussenBHEdvardssonD.Falling behind: A substantive theory of care for older people with cognitive impairment in acute settings. J Clin Nurs. 2013;22(11–12):1682–1691.
54.
EdvardssonDNilssonAFetherstonhaughDThe person-centred care of older people with cognitive impairment in acute care scale (POPAC). J Nurs Manag. 2013;21(1):79–86.
MillaudF.Malades mentaux criminels: La prise en charge judiciaire au Québec. In: de BeaurepaireCBénézechMKottlerC, editors. Les dangerosités: De la criminologie à la psychopathologie, entre justice et psychiatrie. Paris (FR): John Libbey Eurotext; 2004.
