Out of area admissions to two independent sector PICUs: patient characteristics, length of stay and delayed discharges

Haw, Camilla; Otuwehinmi, Olufunke; Kotterbova, Eva

doi:10.20299/jpi.2016.020

Cited by 3 publications

(3 citation statements)

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“…Various statistical distributions (exponential, lognormal, gamma, Weibull) were fitted to the LOS data for each of the three PICUs, with a lognormal distribution found to offer the best fit (as assessed by the Akaike Information Criterion) for each of the three units (Table 1). Note that the estimated LOS is in line with observed in other PICUs, with Haw et al (2017) previously reporting a 22-day median LOS for two PICUs in the UK.…”

Section: Baseline Scenario and Validationsupporting

confidence: 88%

“…The issue of sending patients for treatment outside their geographic area is particularly problematic for psychiatric intensive care, given the high acuity of patient need, the consequences for delayed transfer and admission to patient outcome, and significant resource costs (Dolan & Lawson, 2001;Haw et al, 2017;Pereira et al, 2005). Psychiatric Intensive Care Units (PICU) are low-capacity, highly-staffed, specialised wards, designed to treat acute challenging psychotic behaviour (Brown & Bass, 2004).…”

Section: Introductionmentioning

confidence: 99%

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Exploring financially sustainable initiatives to address out-of-area placements in psychiatric ICUs: a computer simulation study

Moss

Vasilakis

Wood

2022

Journal of Mental Health

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Background: Transferring individuals for treatment outside their geographic area occurs when healthcare demand exceeds local supply. This can result in significant financial cost while impacting patient outcomes and experience. Aims:The aim of this study was to assess initiatives to reduce psychiatric intensive care unit (PICU) out-of-area bed placements within a major healthcare system in South West England. Methods:Discrete event computer simulation was used to model patient flow across the healthcare system's three PICUs. A scenario analysis was performed to estimate the impact of management plans to decrease admissions and length of stay. The amount of capacity required to minimise total cost was also considered. Results:Without increasing in-area capacity, mean out-of-area bed requirement can be reduced by 25.6% and 19.1% respectively through plausible initiatives to decrease admissions and length of stay. Reductions of 34.7% are possible if both initiatives are employed.Adjusting the in-area bed capacity can also lead to aggregate cost savings. Conclusions:This study supports the likely effectiveness of particular initiatives in reducing out-ofarea placements for high-acuity bedded psychiatric care. This study also demonstrates the value of computer simulation in an area that has seen little such attention to date.

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Section: Baseline Scenario and Validationsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Exploring financially sustainable initiatives to address out-of-area placements in psychiatric ICUs: a computer simulation study

Moss

Vasilakis

Wood

2022

Journal of Mental Health

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“…Pereira et al (2021) https://doi.org/10.7748/MHP.2021.E1467 3 https://digital.nhs.uk/data-and-information/publications/statistical/out-of-area-placements-in-mentalhealth-services/september-20214 Haw et al (2016) https://doi.org/10.20299/JPI.2016.020 5 Woods et al (2020) https://doi.org/10.1108/JCP-03-2020-0013; Brugha et al (2005) https://doi.org/10.1176/appi.ajp.162.4.774priority for the adult secure estate is to provide specific expertise and appropriate security to accommodate prisoners (and others with criminal justice engagement) in need of transfer to hospital for inpatient treatment[10,11,12] 8 .2.10 Levels of security within the adult secure estate include High Secure (for immediate and grave risk), Medium Secure (for serious risk) and Low Secure units (for significant risk)[10,11,12].2.11 Only Medium and High Secure hospitals have perimeter security designed to prevent rather than impede absconding.…”

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confidence: 99%

The Referral and Admission of Prisoners to General Adult Psychiatric Intensive Care Units (PICU)

2023

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Delayed discharge in inpatient psychiatric care: a systematic review

Teale,

Morgan,

Jenkins

et al. 2024

Int J Ment Health Syst

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Background Delayed discharge is problematic. It is financially costly and can create barriers to delivering best patient care, by preventing return to usual functioning and delaying admissions of others in need. This systematic review aimed to collate existing evidence on delayed discharge in psychiatric inpatient settings and to develop understanding of factors and outcomes of delays in these services. Methods A search of relevant literature published between 2002 and 2022 was conducted on Pubmed, PsycInfo and Embase. Studies of any design, which published data on delayed discharge from psychiatric inpatient care in high income countries were included. Studies examining child and adolescent, general medical or forensic settings were excluded. A narrative synthesis method was utilised. Quality of research was appraised using the Mixed Methods Appraisal Tool (MMAT). Results Eighteen studies from England, Canada, Australia, Ireland, and Norway met the inclusion criteria. Six main reasons for delayed discharge were identified: (1) accommodation needs, (2) challenges securing community or rehabilitation support, (3) funding difficulties, (4) family/carer factors, (5) forensic considerations and (6) person being out of area. Some demographic and clinical factors were also found to relate to delays, such as having a diagnosis of schizophrenia or other psychotic disorder, cognitive impairment, and increased service input prior to admission. Being unemployed and socially isolated were also linked to delays. Only one study commented on consequences of delays for patients, finding they experienced feelings of lack of choice and control. Four studies examined consequences on services, identifying high financial costs. Conclusion Overall, the findings suggest there are multiple interlinked factors relevant in delayed discharge that should be considered in practice and policy. Suggestions for future research are discussed, including investigating delayed discharge in other high-income countries, examining delayed discharge from child and forensic psychiatric settings, and exploring consequences of delays on patients and staff. We suggest that future research be consistent in terms used to define delayed discharge, to enhance the clarity of the evidence base. Review registration number on PROSPERO 292515. Date of registration 9th December 2021.

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Out of area admissions to two independent sector PICUs: patient characteristics, length of stay and delayed discharges

Cited by 3 publications

References 0 publications

Exploring financially sustainable initiatives to address out-of-area placements in psychiatric ICUs: a computer simulation study

Exploring financially sustainable initiatives to address out-of-area placements in psychiatric ICUs: a computer simulation study

The Referral and Admission of Prisoners to General Adult Psychiatric Intensive Care Units (PICU)

Delayed discharge in inpatient psychiatric care: a systematic review

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