The Five-Year Evolution of a Mixed Psychiatric and Somatic Care Unit: A European Experience

Alberque, Christel; Gex‐Fabry, Marianne; Whitaker-Clinch, Barbara; Eytan, Ariel

doi:10.1176/appi.psy.50.4.354

Cited by 13 publications

(21 citation statements)

References 15 publications

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“…At least 25% of the patients in a general hospital have psychiatric comorbidity [13][14][15]. Several studies show that dementia, anxiety disorders, substance-related disorders and mood disorders are the most common [6,[15][16][17]. Most of the time it is not necessary to treat these patients at a special ward and their needs of psychiatric treatment are sufficiently met by the psychiatric consultation and liaison service.…”

Section: Discussionmentioning

confidence: 99%

“…And when eventually admitted, they may be discharged or transferred too early to another ward because of behavioural issues. Often, the complexity of care for these patients may exceed the competence level of the usual healthcare worker [6]. A retrospective case-note study from our MPU [7] shows that most patients who were secondarily admitted to the MPU had behavioural problems (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…Limited literature is available on the topic of combined care at a MPU, while the number of this specific group of patients in need of this care is increasing [5,6,8,9]. 9% of all the patients referred to the MPU are trauma patients [7].…”

Section: Introductionmentioning

confidence: 99%

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A mixed psychiatric and somatic care unit for trauma patients: 10 years of experience in an urban level I trauma center in the Netherlands

Dekker

Heller

Meij

et al. 2019

Eur J Trauma Emerg Surg

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Background A medical-psychiatric unit (MPU) is a special ward where staff is trained in caring for patients with psychiatric or behavioural problems that need hospitalisation for physical health problems. It is well known that these patients are at higher risk of complications and have a longer length of stay resulting in higher costs than patients without psychiatric comorbidity. The objective of this study was to analyse the trauma patient population of the first 10 years of existence of the MPU in a level I trauma center. Patients and methods A retrospective analysis was performed in 2-year cohorts from 2006 to 2016. All trauma patients admitted to the MPU were compared with the overall trauma patient population in VUmc. Data (psychiatric diagnosis, substance abuse, trauma scores, surgical interventions, complications, mortality) were extracted from individual patient notes and the Regional Trauma Registry. Results 258 patients were identified. 36% of all patients had a history of previous psychiatric admission and 30% had attempted suicide at least once in their lifetime. Substance abuse was the most common psychiatric diagnosis (39%), with psychotic disorder (28%) in second place. The median hospital stay was 21 days. Median MPU length of stay was 10 days (range 1-160). Injuries were self-inflicted in 57%. The most common mechanism of injury was fall from height with intentional jumping in second place. Penetrating injury rate was 24% and 33% had an ISS ≥ 16, compared to 5% and 15%, respectively, in the overall trauma patient population. The most common injuries were those of the head and neck. Complication rate was 49%. Conclusion Trauma patients that were admitted to the MPU of an urban level I trauma center had serious psychiatric comorbidity as well as high injury severity. Penetrating injury was much more common than in the overall trauma patient population. A high complication rate was noted. The high psychiatric comorbidity and the complicated care warrants combined psychiatric and somatic (nursing) care for this subpopulation of trauma patients. This should be taken into account in the prehospital triage to a trauma center. The institution of a MPU in level I trauma centers is recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A mixed psychiatric and somatic care unit for trauma patients: 10 years of experience in an urban level I trauma center in the Netherlands

Dekker

Heller

Meij

et al. 2019

Eur J Trauma Emerg Surg

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“…Wechselbeziehungen zwischen körperlichen und psychischen Erkrankungentherapeutische Aspekte [58]. Für Patienten, die aufgrund der Schwere der körperlichen und psychischen Beeinträchtigung weder auf einer somatischen noch einer psychiatrischen Einheit üblichen Zuschnitts behandelt werden können, stellen interdisziplinär besetzte Stationen eine Bereicherung des Angebots dar [59,60]. Nicht zuletzt sind sozialpsychiatrische Institutionen zu nennen.…”

Section: Somatische Sekundärkomplikationen Bei Schweren Psychischen Sunclassified

Körperliche Erkrankungen bei psychiatrischen Patienten

Hewer¹,

Füeßl²,

Hermle³

2011

Fortschr Neurol Psychiatr

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“…Erasmus MC, a large University Medical Center in Rotterdam, the Netherlands, aims to inaugurate an MPU in 2019. The reasons for establishing such a unit fall into several categories: 1) managing the increasing complexity and behavior that is disruptive to somatic treatment in an aging and more often multimorbid population [6–9], 2) improving the quality of care [9], and 3) the promise of cost-effectiveness by reducing length of stay and readmissions [8, 10]. A needs assessment is generally advised before establishing such a unit [11, 12].…”

Section: Introductionmentioning

confidence: 99%

Need analysis for a new high acuity medical psychiatry unit: which patients are considered for admission?

Caarls

Schijndel

Kromkamp

et al. 2019

BMC Health Serv Res

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Background The study aims were: to estimate the proportion of patients with an indication for admission to a new high acuity Medical Psychiatric Unit (MPU), to explore the reasons for MPU-admission according to different health disciplines, and to check for differences in patient characteristics. The results of this study are to be utilized in the proposed establishment of a high-acuity MPU in a University Medical Center. Such a unit currently does not exist at Erasmus MC. Methods Hospital in-patients were included if they received psychiatric consultation from the Psychiatric Consultative Service (PCS). As part of the study protocol, psychiatrists, other medical specialists, and nurses determined the need for admission to the proposed MPU. Patient groups were compared with respect to diagnoses, socio-demographic characteristics and patient routing. Results One hundred and fifty-one patients were included, 43% had an indication for MPU-admission, for the other patients PCS involvement was sufficient. There was agreement on suicide attempts as a reason for MPU-admission. For psychiatrists, the need for further diagnostic evaluation was a common reason for MPU admission, while other medical specialists more often emphasized the need for safety measures. Patients with an unplanned hospital admission had a higher chance of MPU eligibility (OR = 2.72, 95% CI 1.10–6.70). The main psychiatric diagnoses of MPU-eligible patients were organic disorders (including delirium), mood disorders, and disorders related to substance abuse. The most common diagnoses found were similar to those in previous research on MPU populations. Conclusion Different medical disciplines have different views on the advantages of MPUs, while all see the need for such facilities. The proposed MPU should be able to accommodate patients directly from the Emergency Unit, and the MPU should provide specialized diagnostic care in an extra safe environment.

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The Five-Year Evolution of a Mixed Psychiatric and Somatic Care Unit: A European Experience

Cited by 13 publications

References 15 publications

A mixed psychiatric and somatic care unit for trauma patients: 10 years of experience in an urban level I trauma center in the Netherlands

A mixed psychiatric and somatic care unit for trauma patients: 10 years of experience in an urban level I trauma center in the Netherlands

Körperliche Erkrankungen bei psychiatrischen Patienten

Need analysis for a new high acuity medical psychiatry unit: which patients are considered for admission?

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