Organization and Outcomes of Integrated Inpatient Medical and Psychiatric Care Units: A Systematic Review

Abstract

The goal of this review was to assess the relationships among aims, designs, and outcomes of integrated inpatient medical and psychiatric care units (IMPUs) and gather the evidence base on the effectiveness of these units.Methods: Using online searches of Embase, Medline, Web of Science, PsycINFO, Scopus, CINAHL, Cochrane, and Google Scholar, the authors identified and reviewed literature describing the aims and outcomes of specific IMPU designs. Results:The search yielded 55 studies, in which the authors identified 39 IMPUs that focused on patients with mood, psychotic, somatic symptom, substance use, organic, and personality disorders and a broad array of medical diagnoses. Most units were psychiatric-medical units and had medium medical and psychiatric acuity capabilities. The studies reviewed provided little information on the costeffectiveness of various IMPU designs. Although some comparative studies indicated reductions in hospital length of stay (LOS), these studies were generally of low quality and rarely reported other intended outcomes.Conclusions: IMPUs may help shorten LOS. IMPUs should focus care on patients with complex conditions and high acuity to maximize health system value. Implementing compulsory admission facilities; qualified psychiatric, medical, and nursing staff involvement; and cross-disciplinary training may improve IMPUs' capacity to treat high-acuity patients. Future research should relate IMPU designs to intended outcomes.

Moving Beyond the Status Quo of Integrated Inpatient Medical and Psychiatric Care Units: The Path to Real-World Evaluation

“…In contrast, some IMPUs are longer-stay wards. The latter units emphasize functional recovery and resocialization (1). These variable IMPU types imply different underlying goals, acuity capabilities, and outcomes.…”

“…When pragmatic reasoning, where clinical expertise and organizational needs determine IMPU designs, is replaced with EBP, researchers can more effectively perform studies that may convince health care policy makers that IMPUs represent a costeffective way to improve patients' health and that they increase the well-being of both patients and hospital staff. Integrated inpatient medical and psychiatric care units (IMPUs) are hospital wards that serve acute patients with both general medical and psychiatric disorders (1). Patients with these co-occurring disorders do not always receive appropriate care, resulting in poor clinical and functional outcomes as well as higher cost of care (2).…”

“…As a result, most studies of IMPUs have been observational, and 40 years after the first IMPU was established, little can be said about patient and economic outcomes of IMPU care (1,4). It is therefore time for a different approach.…”

Defining Vision and Mission of a Medical Psychiatry Unit (MPU) for Older Adults: A Focus Group Study

“… 2 , 9 The integration of mental and physical healthcare is a top priority in national and international policy documents. 3, 8 - 11 …”

“…A hospital ward where physical and mental issues are addressed together is called a medical psychiatry unit (MPU). 10 , 11 MPUs close the gap between psychiatric wards, that are usually not equipped to deal with more than minimal medical or surgical problems, and medical wards that have limited tolerance for patients with a psychiatric disorder or behavioral problems. 12 - 14 These units are complementary to psychiatric consultation services when biopsychosocial complexity is severe.…”