Risk factors for long-stay in an Italian acute psychiatric ward: a 7-year retrospective analysis

Abstract

Background: In West during the last decades, the phenomenon of "bed blockers" has been more frequently investigated, probably because of increasing economic constraints in the management of public health. According to most authors, the lack of rehabilitation facilities, organizational problems within the hospital, the long wait for medical consultations and\ud diagnostic procedures would be the main causes of "delayed discharge". Early studies were carried out in long-term care, rehabilitation and post-acute geriatric wards. In Psychiatry, the few studies on this topic highlighted a wide range of causes, including both patient conditions and organizational health system problems. In Italy, the problem of psychiatric delayed discharges has become more pressing after the 180 Law, which established the closure of all psychiatric hospitals and implemented psychiatric wards inside General Hospitals to admit only 15 acute patients for a very short period.\ud Purposes: To highlight the phenomenon of long-stay in an acute psychiatric ward and to relate it to demographic, clinical and organizational variables.\ud Methods: The survey was conducted in the 15-bed public psychiatric ward of Modena (Italy). All admissions were retrospectively collected from the database of the Department from 1 January 2005 to 31 December 2011 (3981 hospitalizations with an average stay of 12.49 days). Demographic data, clinical variables, inpatient care problems, discharge programs were statistically related to the duration of admissions (survival analysis: log-rank test, Kaplan-Meier\ud curves). The 3981 hospitalizations were divided into two groups according to the 90° percentile of duration: < 27 days (n=3575) and ≥ 27 days (n=406) and the variables of the two groups were compared (multiple logistic regression). Secondary analysis was conducted on the subgroup of the longest hospitalizations further divided into two groups according to the 90° (from 27 days to < 36 days) and 95° percentile (≥36 days), in order to find out variables related (survival analysis: log-rank test; multiple logistic regression test).\ud Results: The longest hospitalizations (≥27 days) represent 11% of all admissions during the observation period. When all variables are compared to the duration of hospitalizations, most of them are statistically significantly related to the length of hospitalizations, but, when statistical analysis was focused on the comparison between the two groups of the longest hospitalizations, a smaller number of variables (“gender”, “age”, “rehabilitative programs”, “extra-psychiatric clinical activities”, “pharmacotherapy” and “aggressiveness of patient”) were identified by survival analysis as statistically significant correlates of long-stay (log-rank test), whereas only “female gender” and aggressiveness pf patient” were the variables statistically significantly related to the length of hospitalizations evidenced by multivariate logistic regression analysis.\ud Conclusions: Our results suggest that a wide range of factors may be respons...

<p>Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward</p>

“…The pathologies in the group of patients with the longest hospitalizations were serious and potentially disabling, such as schizophrenia and other psychotic spectrum disorders, in accordance with data reported in the literature. 9,34 The factors which conditioned the LOS were constituted by complex psychiatric activities during hospitalization and at discharge involving of family members or caregivers, pharmacological therapies administered by multiple routes, intensive rehabilitation programs provided by ward staff and/or other services, and both mild and severe aggressive behavior. Altogether, these clinical and organizational variables indicate that patients who remain hospitalized for a very long time are characterized by multiple care needs closely related to the severity of psychiatric pathologies and not to organic comorbidities or social disadvantage.…”

Clinical and Organizational Factors Related to the Reduction of Mechanical Restraint Application in an Acute Ward: An 8-Year Retrospective Analysis

“…Therefore, according to our data, we can emphasize that the use of mechanical restraint can be considered a marker of clinical severity and complexity. In fact, patients involuntarily admitted due to hostility and lack of cooperation, and patients hospitalized longer due to many critical issues reporting discharge were more frequently restrained [ 62 ].…”

An alternate level of care plan: Co‐designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges

“…Alternate Level of Care (or 'ALC') is a construct used in Canada to refer to a delay in hospital discharge 1 ; a common care quality challenge experienced across Canada [1][2][3] and worldwide. [4][5][6] In acute care, an ALC designation is typically given when a person has finished their medical treatment, has been cleared for discharge (usually by a physician) and is waiting for their next point of care 2,7 such as long-term care (ie, nursing home), home with services, assisted living or rehabilitation. When these destinations are not available, a person is stuck waiting in hospital.…”