Patient and service-level factors affecting length of inpatient stay in an acute mental health service: a retrospective case cohort study

Abstract

Background The NHS Mental Health Implementation Plan aims to reduce length of inpatient psychiatric stays to a maximum of 32 days, yet provides little guidance on how to achieve this. Previous studies have attempted to analyse factors influencing length of stay in mental health units, focussing mostly on patient factors. These models fail to sufficiently explain the variation in duration of inpatient stay. We assess how the type of service delivered by a trust, in addition to patient factors, influences length of stay. Methods We conducted a retrospective case cohort study in a large inner-city NHS mental health trust for all admissions in a 1 month period. Data was gathered from electronic notes of 105 patients. Descriptive univariate and bivariate analyses were conducted on the data, with multiple regression analysis conducted on statistically significant data. Results Short-stay assessment ward admission significantly reduced length of stay. Patients under outpatients or under care co-ordination, admitted through Mental Health Act assessment and formally detained all had longer length of stay. Out of area admissions, locum Consultant care, changing Responsible Clinician and ward transfers all led to longer length of stay. Factors indicating more severe illness such as increased observation level and polypharmacy, as well as diagnoses of psychosis or bipolar disorder were associated with longer duration of stay. Discharges requiring referral to accommodation or rehabilitation led to longer stays. The most significant factors that influenced length of stay were higher observation levels, diagnosis of psychotic illness or bipolar, and discharge to rehabilitation placement. The final model, taking into account all these factors, was able to account for 59.6% of the variability in length of stay. Conclusions The study backs up existing literature which shows patient-factors have an influence on length of stay. The study also demonstrates that service-level factors have an impact on the duration of stay. This data may be used to inform further studies which may aid provision of inpatient and community services in the future.

The Impact of Legal Procedures on Hospital Length of Stay: Balancing Legal and Clinical Concerns

“…bles of primary interest. In contrast, most previous studies focused on patient-related factors including sociodemographic and clinical factors [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], hospital or regional characteristics [6,[15][16][17]21], or provider-or service-related factors [18][19][20][21][22], less on legal factors. For example, some studies included legal status as a predictor of LOS but did not show the actual day information [6,21]; specifically, Compton et al reviewed legal status at admission and at discharge, not court-ordered treatment.…”

“…Moreover, medical comorbidity was associated with a >10% increase in psychiatric symptoms and functional impairment at discharge, even after adjusting for clinical status at admission [14]. Some studies utilized a comprehensive set of static vs. dynamic or external vs. internal factors to better understand the mechanism of LOS [5][6][7][15][16][17][18][19][20][21][22]. Factors external to patients or providers such as insurance coverage, reimbursement policies, and institutional characteristics have been shown to influence LOS.…”

“…Factors external to patients or providers such as insurance coverage, reimbursement policies, and institutional characteristics have been shown to influence LOS. Provider-level factors, regional characteristics, hospital type, service-level factors, and case-mix were also associated with variations in length of hospitalization [15][16][17][18][19][20][21][22]. An Australian study by Zhang et al asserted that LOS at an acute psychiatric inpatient unit can be predicted using a multifactorial approach; in particular, behavioral manifestations of illness and lack of social support structures are critical.…”

Attachment-based CBT models for psychosis: a PPI-informed approach for acute care settings

“…People with psychosis tend to have prolonged hospital admissions (Crossley and Sweeney, 2020;Lay et al, 2006), despite the now 20-year-old NHS Implementation Plan and target of 32-day maximum average stays (Department of Health, 1999;NHS England, 2019). In a recent retrospective cohort study of a large inner-city mental health NHS Trust, a psychosis diagnosis was associated with longer admissions, with an average length of stay of over two months (Crossley and Sweeney, 2020).…”

Predictors of Length of Hospitalization and Impact on Early Readmission for Mental Disorders

“…Some studies have previously assessed associations between length of hospital stay and early readmission, but have mostly considered patient sociodemographic and clinical characteristics. Longer-stay hospitalization and early readmission were both linked with unemployment [ 2 , 6 , 15 ], homelessness [ 6 , 15 ], having never been married [ 6 , 10 , 16 ], serious MD [ 6 , 17 , 18 ], previous hospitalizations [ 1 , 19 ], and lack of discharge planning [ 1 , 20 ]. Longer-stay hospitalizations only were linked with co-occurring MD/physical illnesses [ 21 ] and more structured or supervised aftercare [ 18 ], while short-stay hospitalizations were associated with patients having more SRD [ 1 , 16 , 22 ].…”