Observed-predicted length of stay for an acute psychiatric department, as an indicator of inpatient care inefficiencies. Retrospective case-series study.

The use of dialectical behavioral therapy (DBT) among a variety of programs and patients has recently exploded. Of particular interest is the use of DBT in partial hospital (PH) programs due to the high number of severely ill and suicidal patients who participate in these programs. Recently, Lothes, Mochrie and St. John (2014) examined data from a local DBT-informed PH program and found significant reductions in depression, anxiety, hopelessness, and degree of suffering from intake to discharge. The present study examined these same four symptom constructs by assessing intake and discharge data for additional individuals enrolled in this DBT-informed PH program. In addition, lengths of stay and acuity ratings were analyzed to explore the relationship between these variables and symptom constructs. Significant symptom reduction in depression, anxiety, hopelessness, and degree of suffering from intake to discharge was found among high and medium acuity patients, replicating the results of Lothes et al. (2014). Further, individuals with the highest acuity saw the largest reduction in hopelessness symptoms the longer they participated in the program (i.e., a significant interaction effect between acuity and length of stay). This is meaningful given the connection between hopelessness and suicidal ideation/action, which is of particular concern for those charged with treating clinical populations. DBT-informed PH programs may be a cost-effective and useful way to treat high-risk patients who come from inpatient facilities. Future studies may wish to create follow-up periods (i.e., 3 months, 6 months) post-discharge to assess if symptom reduction remains.

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“…Length of stay was measured by total number of days in the program, consistent with previous research (Jiménez, Lam, Marot, & Delgado, 2004).…”

Section: Length Of Staymentioning

confidence: 81%

Evaluation of a dialectical behavior therapy-informed partial hospital program: outcome data and exploratory analyses

Lothes

Mochrie

Quickel

et al. 2016

ResPsy

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“…Previous studies 17,[21][22][23][24] have also shown that older age, cognitive impairment, 23,24 functional dependence, 23 as well as the presence of multiple comorbidities and physical illnesses 25 were associated with longer hospital LOS for psychiatric patients. Additionally, diagnoses of schizophrenia, 26,27 psychotic or mood disorders, 21,22 and the presence of aggression or agitation 26 are associated with longer hospital stays.…”

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confidence: 99%

“…Additionally, diagnoses of schizophrenia, 26,27 psychotic or mood disorders, 21,22 and the presence of aggression or agitation 26 are associated with longer hospital stays. Our study's objective was to describe psychiatric patients occupying acute beds in a psychiatric unit and based on their needs, to determine the level of care required (acute, compared with nonacute) at day 30 of hospitalization.…”

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confidence: 99%

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

et al. 2015

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Objective: 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. W W W Caractéristiques et besoins des patients psychiatriques dont le séjour à l'hôpital est prolongéObjectif : Décrire les caractéristiques et les besoins, avant l'hospitalisation, au moment de l'admission, durant le premier mois, au 30 e jour d'hospitalisation et après le congé de l'hôpital de patients psychiatriques occupant des lits de soins actifs.Méthode : Cette étude d'observation prospective a été menée dans 2 hôpitaux de soins tertiaires. Les patients adultes hospitalisés dans une unité psychiatrique pendant 30 jours ont été identifiés. Les données ont été recueillies dans leurs dossiers médicaux et par des entrevues avec leur équipe de soins de santé. La catégorisation du statut aigu et non aigu au 30 e jour se fondait sur l'évaluation des professionnels de la santé. Des analyses descriptives et univariées ont été exécutées.Résultats : Un total de 262 patients ont été identifiés (âge moyen 45 ans), dont 66 % vivaient à la maison et 11 % étaient sans abri. Plus de la moitié étaient cognitivement déficients et quelques-uns avaient des besoins médicaux spéciaux. Quatre-vingt

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“…Es importante destacar que dos terceras partes de la muestra estuvo recibiendo combinación de fármacos por vía oral (antipsicóticos típicos y atípicos, ansiolíticos, entre otros), sin embargo, en el trabajo de Jiménez et al (13) a pesar de tomar como factor predictor el uso de psicotrópicos prevalece el de antipsicóticos solos en un 38,5 % asumiendo que no da lugar a combinaciones posteriores, lo cual resulta incomparable a nuestros hallazgos. Nuestro estudio en función a la evolución favorable de los pacientes, deja una vez más abierta la posibilidad de que el factor más importante asociado a la estancia hospitalaria, no es el factor clínico, sino que, a pesar del buen manejo de los pacientes y su evolución favorable, se atribuyen factores sociales, personales y judiciales, principalmente, que escapan al control del equipo de salud del personal y por ende al cumplimiento de los estándares establecidos para una adecuada estancia hospitalaria, concordando también con los hallazgos de Cheng (14) , pero contrapuesto a Anderson (15) y Øiesvold (16) , que dan mayor importancia a la complejidad clínica (por ejemplo, estados psicóticos y admisiones planificadas) y no otros factores.…”

Section: Discussionunclassified

Características personales, clínicas y sociales en pacientes con estancia hospitalaria prolongada en los pabellones de pacientes agudos del Hospital Víctor Larco Herrera

et al. 2018

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Observed-predicted length of stay for an acute psychiatric department, as an indicator of inpatient care inefficiencies. Retrospective case-series study.

Cited by 49 publications

References 38 publications

Evaluation of a dialectical behavior therapy-informed partial hospital program: outcome data and exploratory analyses

Evaluation of a dialectical behavior therapy-informed partial hospital program: outcome data and exploratory analyses

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

Características personales, clínicas y sociales en pacientes con estancia hospitalaria prolongada en los pabellones de pacientes agudos del Hospital Víctor Larco Herrera

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