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Background Unplanned readmissions rates are an important indicator of the quality of care provided in a psychiatric unit. However, there is no validated risk model to predict this outcome in patients with psychotic spectrum disorders. Aims This paper aims to establish a clinical risk prediction model to predict 28-day unplanned readmission via the accident and emergency department after discharge from acute psychiatric units for patients with psychotic spectrum disorders. Method Adult patients with psychotic spectrum disorders discharged within a 5-year period from all psychiatric units in Hong Kong were included in this study. Information on the socioeconomic background, past medical and psychiatric history, current discharge episode and Health of the Nation Outcome Scales (HoNOS) scores were used in a logistic regression to derive the risk model and the predictive variables. The sample was randomly split into two to derive (n = 10 219) and validate (n = 10 643) the model. Results The rate of unplanned readmission was 7.09%. The risk factors for unplanned readmission include higher number of previous admissions, comorbid substance misuse, history of violence and a score of one or more in the discharge HoNOS overactivity or aggression item. Protective factors include older age, prescribing clozapine, living with family and relatives after discharge and imposition of conditional discharge. The model had moderate discriminative power with a c-statistic of 0.705 and 0.684 on the derivation and validation data-set. Conclusions The risk of readmission for each patient can be identified and adjustments in the treatment for those with a high risk may be implemented to prevent this undesirable outcome.

Introduction: The practice model of case‐by‐case evaluation by a combined microsurgical and endovascular team based on the individual characteristics of each ruptured intracranial aneurysms, is the model used in most neurovascular centres in the US and in our centre. We aim to audit the outcome and cost (in terms of intensive care unit stay and hospital stay) in the microsurgical treatment group and endovascular treatment group. Methods: The records of patients having ruptured anterior communicating artery aneurysm admitted to our unit between 1996 and 2002 were reviewed. A total of 54 patients were reviewed. Twenty‐seven patients had endovascular treatment and 27 patients had microsurgical treatment. Results: The profiles for age, sex and admitting WFNS grading and Fisher grading were similar between the endovascular treatment and microsurgical treatment groups. Two patients in the endovascular group and one patient in the microsurgical group need further treatment for recurrent aneurysm. The mean intensive care unit stay is 7 days for the microsurgical group and 5 days for the endovascular group (P=0.40). The mean hospital ward stay is 20 days for the microsurgical group and 27 days for endovascular group (P=0.31). Favourable outcome was achieved in 70% of patients in 1 year in both groups of patients. Conclusion: The outcome in both microsurgical and endovascular groups is satisfactory. There is no difference in terms of outcome and cost analysis between the two groups. The practice model of case‐by‐case evaluation by a combined microsurgical and endovascular team based on the individual characteristics of each ruptured intracranial aneurysm should be continued.