The “revolving Door Phenomenon” in an Acute Psychiatric Ward: a 5-year Retrospective Analysis

Abstract

IntroductionThe term ‘revolving door (RD) phenomenon” was coined to define recurrent hospitalizations of chronically ill patients after closure of psychiatric hospitals and implementation of community treatments.ObjectivesContinued readmissions require a large portion of Mental Health Departments’ resources.AimsTo analyze the RD phenomenon in an acute psychiatric ward during a 5-year period.MethodsWe retrospectively selected all patients with 3 or more hospitalizations per year from 01/01/ 2009 to 31/12/2013 in SPDC-Modena Centro. From their medical records we collected selected variables, potential predictors of RD phenomenon. Data were statistically analyzed.ResultsIn the 5-year period, a sample of 105 patients (47 females, 58 males) with an average age of 40.25 years (± 13.47 SD), 5.68 % of all inpatients (n = 1850), realized 778 hospitalizations, 23.94 % of all admissions (n=3250). The most frequent reason for admission was ‘worsening of psychiatric symptomatology” (55.27%). The most frequent diagnoses at discharge were ‘Schizophrenia” (41.26%) and ‘Personality Disorders” (25.32%). Most of RD patients (87%) were Italian, only 15 % were employed and 50 % lived with family. The mean duration of RD hospitalizations (12.23 days ± 18.37 SD) was statistically significantly different from all others in the 5-year period (10.39 days ± 11.09 SD, p=0.0008, t test) as was the frequency of compulsory admissions (RD hospitalizations 18% vs. 26% all others, chi2, p<0.001).ConclusionsOur RD patients represented a small percent of all inpatients but required many and long hospitalizations, probably due to severe and disabling illness.

The reMAP project: A retrospective, 15‐year register study on inpatient care for youth with mental disorders

“…In Italy, the Revolving Door phenomenon was analysed by very few studies (Barbato, Terzian, Saraceno, Montero Barquero, & Tognoni, 1992) that attempted to frame it within the complexity of changes introduced by the 1978 mental health reform act in Italian psychiatric services (Amaddeo & Barbui, 2018). Recent evidence (Di Lorenzo, Sagona, Landi, et al, 2016) of a higher revolving rate for personality disorders and manic episodes is not confirmed in our study. Such discrepancy further outlines the need for shared criteria to define the revolving door phenomenon and its systematic use across the studies.…”

“…Gender and nationality were not found to influence RD, neither on the whole sample nor performing the analysis on each diagnostic cluster. Indeed, gender has not been found to influence length of stay (Dimitri et al, 2018) nor Revolving Door in other studies (Haywood et al, 1995) and the lack of association reported here is also in line with a recent study from a similar mental healthcare setting (Di Lorenzo et al, 2016…”

“…Due to the relatively low number observed, no reliable data on specific diagnostic clusters nor overall trends could be identified. Despite a constant growth of awareness over adolescent mental health and a well‐established increase of diagnoses requiring both inpatient and outpatient care, research from Italian services is limited (Di Lorenzo et al, 2016). One site‐specific explanation for the limited number of admissions observed in our population is the broad collaborative effort between the child and adolescent outpatient service and paediatric ward, which are structurally and functionally interconnected in San Paolo Hospital.…”

Risk factors for repeated emergency compulsory psychiatric admissions

“…This, too, is in accordance with the literature on revolving-door patients. [3][4][5][6][7] Our finding with regard to ethnicity requires some deliberation. Although one would expect ethnicity other than that of the majority group to be associated with a higher risk of repeated ECPA, 16 it was clear from the regional differences that ethnicity was important mainly in Amsterdam.…”

“…Most of the little research that has been done on 'revolving-door' patients has focused on voluntary admissions. [3][4][5][6][7] It found four predictors of frequent readmissions: a history of previous psychiatric admissions, a diagnosis on the psychosis spectrum, being unemployed and living in residential accommodation. But few studies have investigated the prevalence of repeated compulsory psychiatric admissions and their risk factors.…”