Factors in Delays in Discharge from Acute-Care Psychiatry

Kelly, Ann V.; Watson, Diane; Raboud, Janet; Bilsker, Dan

doi:10.1177/070674379804300508

Cited by 14 publications

(18 citation statements)

References 5 publications

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“…Dementia has been correlated with delayed discharges in geriatric psychiatry (Hanif and Rathod 2008 ; Paton et al 2004 ; Poole et al 2014 ), although it remains poorly understood because it is often conflated with older age, which is also implicated in delays (Butterill et al 2009 ; Kelly et al 1998 ; Tanioka et al 2013 ). Schizophrenia is another diagnosis that is frequently seen among those experiencing delays (Butterill et al 2009 ; Kelly et al 1998 ; Poole et al 2014 ). However, diagnoses do not allow us to identify potential mechanisms related to delayed discharge.…”

mentioning

confidence: 99%

Clinical Predictors of Delayed Discharges in Inpatient Mental Health Settings Across Ontario

Little

Hirdes

Perlman

et al. 2018

Adm Policy Ment Health

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Delayed discharges constitute an ongoing issue in psychiatric facilities. This study examined clinical predictors of 30-day delayed discharges in all designated inpatient mental health units within Ontario, Canada. Data for 76,184 inpatient episodes were obtained from 68 psychiatric facilities between 2011 and 2013. Risk factors for delayed discharges were analyzed using multivariate logistic regression. Indicators of functional, social, and cognitive impairment positively predicted delayed discharges, while symptoms of mental illness were inversely related. Policy makers and mental health care practitioners may utilize early predictors of delayed discharges to introduce treatment interventions and policies that reduce the risk of delays in mental health settings.

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confidence: 99%

Clinical Predictors of Delayed Discharges in Inpatient Mental Health Settings Across Ontario

Little

Hirdes

Perlman

et al. 2018

Adm Policy Ment Health

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“…Kelly et al [18] examined factors in delays in discharge from acute-care psychiatry and threw a survey of 327 patients from 12 psychiatry units. It included the use of the Brief Psychiatric Rating Scale (BPRS) and the Discharge Readiness Inventory (DRI).…”

Section: Literature Reviewmentioning

confidence: 99%

Psychiatric Discharge Process

Alghzawi

2012

ISRN Psychiatry

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Background. Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Discharge planning is an essential process in psychiatric nursing field, in order to prevent recurrent readmission to psychiatric units. Objective. The purpose of this paper is to perform literature overview on psychiatric discharge planning, in order to develop evidence-based practice guideline of psychiatric discharge plan. Methods. A search of electronic databases was conducted. The search process aimed to locate different levels of evidence. Inclusion criteria were studies including outcomes related to prevention of readmission as stability in the community, studies investigating the discharge planning process in acute psychiatric wards, and studies that included factors that impede discharge planning and factors that aid timely discharge. On the other hand, exclusion criteria were studies in which discharge planning was discussed as part of a multi faceted intervention and was not the main focus of the review. Result. Studies met inclusion criteria were mainly literature reviews, consensus statements, and descriptive studies. All of these studies are considered at the lower levels of evidence. Conclusion. This review demonstrated that discharge planning based on general principles (evidence based principles) should be applied during psychiatric discharge planning to make this discharge more effective. Depending on this review, it could be concluded that effective discharge planning includes main three stages; initial discharge meeting, regular discharge meeting(s), and leaving from hospital and discharge day. Each stage of them has requirements should be accomplished be go to the next stage.

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“…4 Delayed discharges are estimated to occur for 27 to 58% of acute-care psychiatric inpatients, who remain in this most costly form of mental health service beyond the time that they are actually ready for independent discharge. 5 When compared with community-based care, partial hospitalization alternatives or independent living, 6,7 the costs of unnecessarily keeping people in a 24-h inpatient setting seems to be, at best, a misallocation of funds. 8,9 On both economic and humanitarian grounds, the field sorely needs practical assessment tools that could assist with reliably estimating time-torelease (TTR) for individual psychiatric inpatients.…”

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confidence: 98%

“…5,[22][23][24][25] None of these studies included assessment of abnormal motor behavior or of the stereotypy/ variability of maladaptive behavior found by Paul and Mariotto 3 to predict independent discharge successes from TSBC higher-order scores.…”

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confidence: 99%

“…Non-optimal independent discharge-readiness decisions have been reported to occur because of a variety factors, including staff misperceptions of the continuing need for services, presumptions regarding ongoing problematic behavior, assumptions regarding the need for medication stabilization, family willingness or unwillingness to receive the individual, and lack of community resources. 4,5 Of course, accurate information on the nature and stability of inpatient functioning should be the crucial foundation underlying the discharge decision-making process. 12 Achieving optimal lengths of stay requires objective and reliable assessment of inpatient functioning.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Predicting Time-to-Independent-Release from Current Level of Functioning for Psychiatric Inpatients: A “Survivor” Analysis

Springer

Paul

2007

J Behav Health Serv Res

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Non-optimal psychiatric discharges occur frequently and result in high costs. The Time-Sample Behavioral Checklist (TSBC) has been demonstrated to be the best method for determining successful independent discharge within 2 weeks of assessment for adult inpatients. This study examined the extent to which TSBC indexes and perceived dangerousness predict staff independent discharge-readiness judgments up to 6 months after initial assessment. Data from 22 acute and chronic/mixed units (N = 362) were analyzed using Cox proportional hazard regression. TSBC appropriate interpersonal interaction and appropriate behavior variability predicted shorter time-to-independent-release (TTIR). TSBC bizarre facial expressions and verbalizations predicted longer TTIR. Post hoc analyses suggest that acutely admitted inpatients perceived to be dangerous were discharged sooner than others-a finding that is likely attributable to differential psychotropic medication responsiveness. Implications are discussed for TSBC implementation for earlier identification of discharge-ready inpatients and for tailoring interventions to target behavior that predicts independent discharge success.

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Factors in Delays in Discharge from Acute-Care Psychiatry

Cited by 14 publications

References 5 publications

Clinical Predictors of Delayed Discharges in Inpatient Mental Health Settings Across Ontario

Clinical Predictors of Delayed Discharges in Inpatient Mental Health Settings Across Ontario

Psychiatric Discharge Process

Predicting Time-to-Independent-Release from Current Level of Functioning for Psychiatric Inpatients: A “Survivor” Analysis

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