Diagnostic profile of inpatients as a determinant of length of stay in a general hospital psychiatric unit

Abstract

The aim of this study was to determine if the diagnostic profile of inpatients of a psychiatric unit in a general hospital influences the length of stay. The results of a retrospective survey comprising the first 16 years of operation of the Psychiatric Unit of the Ribeirão Preto General Hospital (PURP) showed that the progressive increase observed in the length of stay correlated with the increase in percentage of schizophrenia diagnosis, after the 8th year of hospital operation, and of affective disorders, after the 12th year. The length of hospitalization kept increasing until the 16th year, even though there was no change in the diagnostic profile of the patients admitted to the unit. In a prospective study encompassing the next six months, 61 inpatients were evaluated with the Structured Clinical Interview for DSM-III-R and the Brief Psychiatric Rating Scale (BPRS). The results showed that 82% of the inpatients fulfilled the diagnostic criteria for the schizophrenic or affective disorder spectrum at admission, with a discharge rate slower than for other diagnoses, although the length of hospitalization did not significantly differ among diagnostic categories. The results further demonstrated that in every diagnostic category more than 50% of the patients stayed in hospital for more than one week after reaching a BPRS score equal to 6, indicative of discharge. Overall, these data suggest that the increase in length of hospitalization may be due to a higher percentage of patients with a diagnosis of schizophrenia and affective disorder admitted to the PURP. In addition, patients with low symptomatic levels remained in hospital longer than they should have.

Determinants of length of stay for psychiatric inpatients: Analysis of a national database covering the entire Korean elderly population

“…Numerous studies have reported that schizophrenia (F2) is positively related to LOS in adults [1,30,[33][34][35]. In Korea, the average LOS in 2005 for patients with schizophrenia was 168.6 days, which was the longest LOS for all mental and behavioural disorders and for all developed countries [1].…”

Serviços de emergência psiquiátrica e suas relações com a rede de saúde mental Brasileira

“…32 This proposal brought about a reduction in the stigma and prejudice associated with mental illness, 33 as well as a closer relationship with other medical specialties, resulting in the provision of a more universal care for patients. 34 Despite the advantages that psychiatric hospitalizations in general hospitals might offer in terms of diagnostic evaluation and clinical management of patients in relation to traditional hospitalizations, 35 some obstacles remain for the implementation of PHUGH. 36 In Brazil, the resistance against the implementation of PHUGH was noticeable in the public administration itself, as well as among the managers and medical staffs of hospitals.…”

Short stay unit for patients in acute mental health crisis: A case‐control study of readmission rates

“…Systematic reviews report no significant differences in readmission rates observed between short and extended stay groups up to 2 years from discharge (Alwan et al, ; Johnstone & Zolese, ), with one older study (Burhan, ) even observing significantly fewer readmissions for patients in the short stay group. Most commonly identified factors increasing the likelihood of a rapid readmission to psychiatric care include younger age, forensic history, severe mental illness, emotionally unstable personality disorder, history of previous admission, acuity of symptoms at admission or discharge, and discharge against medical advice (Callaly, Trauer, Hyland, Coombs, & Berk, ; Durbin, Lin, Layne, & Teed, ; Hallak, Crippa, Vansan, & Zuardi, ; Vigod et al, ). However, little is currently known about factors associated with readmission after discharge from specialized short stay units (Johnstone & Zolese, ).…”