Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-28T16:47:54.607Z Has data issue: false hasContentIssue false
  • English
  • Français

An audit of admissions to an acute psychiatric unit

Published online by Cambridge University Press:  13 June 2014

Margaret Kelleher  and
Sinead O'Brien
Margaret Kelleher
Affiliation:
Department of Old Age Psychiatry, St Camillus' Hospital, Shelbourne Road, Limerick, Ireland
Sinead O'Brien
Affiliation:
Department of Psychiatry, Cork University Hospital, Wilton, Co Cork, Ireland
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: In an era of cost containment in the health services, it is important to endeavour to manage existing resources in the optimum way. This study examines admissions to an acute psychiatric unit in a general hospital in order to identify factors that characterise these admissions, which in turn may suggest appropriate interventions.

Methods: This was a retrospective casenote review of 105 consecutive admissions. Demographic information and clinical data concerning this admission and service contact in the preceding year was collected. Chi-squared tests were used to compare patients who were admitted during normal working hours with those admitted after 5pm and at weekends. Patients whose length of stay exceeded four weeks were compared with those who had a shorter admission.

Results: Eventually 101 patients were included in the study; of these 46.5% of admissions occurred during normal working hours. Admissions outside this time were more likely to be under 45 years (χ2 = 4.05, df = 1, p <0.05) and to be diagnosed with a depressive illness or schizophrenia/psychosis (χ2 = 19.12, df = 3, p <0.05). These admissions were of shorter duration (χ2 = 4.45, df = 1, p <0.05) and had not been in contact with the community psychiatric nurse (CPN) in the preceding year (χ2 = 4.09, df = 1, p <0.05). Length of stay >4 weeks duration was more likely in single patients (χ2 = 9.68, df = 2, p <0.01), those living outside the more urban areas (χ2 = 4.04, df = 1, p <0.05) and those who had a diagnosis of a depressive illness or schizophrenia/psychosis (χ2 = 13.43, df = 3, p <0.01). Patients with a diagnosis of alcohol or substance abuse were spending significantly shorter periods in hospital.

Conclusions: Further development of day hospitals is necessary to provide alternatives to inpatient treatment and facilitate earlier discharge for patients living throughout the catchment area. Alternative methods of service delivery such as outreach programmes should be considered for subgroups of patients who are unable or unwilling to access traditional services. Introducing outpatient detoxification programmes would have a substantial impact on admission patterns in the unit.

Keywords

AuditInpatientsEmergency admissionsLength of stay
Type
Audit
Information
Irish Journal of Psychological Medicine , Volume 18 , Issue 4 , December 2001 , pp. 132 - 136
Copyright
Copyright © Cambridge University Press 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Planning for the Future. Department of Health, 1984. Government Publications, Ireland.Google Scholar
2.Browne, C, Daly, A, Walshe, D. Irish Psychiatric Services; Activities 1998. The Health Research Board, 2000.Google Scholar
3.Fitzpatrick, L, Dunne, E, O'Sullivan, Met al.Alternative acute care. Mid Western Health Board, 1995.Google Scholar
4.Gleisner, J, Hewett, S, Mann, S. Reasons for admissions to hospital. In: Wing, JK, Hailey, AF (eds). Evaluating a community psychiatric service: The Camberwell Register, 1964-71. Oxford University Press 1972; 199–220.Google Scholar
5.Keogh, F, Roche, A, Walsh, D. “We have no beds…” The Health Research Board, 1999.Google Scholar
6.Kiesler, CA, Simpkins, C, Morton, T. Predicting length of hospital stay for psychiatric inpatients. Hosp Commun Psychiatry 1990; 41: 149–54.Google ScholarPubMed
7.Clarke, M, Moran, P, Keogh, F, Morris, M, Kinsella, A, Larkin, C, Walsh, D, O'Callaghan, E. Seasonal influences on admissions for affective disorder and schizophrenia in Ireland: a comparison of first and readmissions. Eur Psychiatry 1999 Sep; 14(5): 251–5.CrossRefGoogle Scholar
8.Krishner, LA, Johnston, L. Length of stay on a short-term unit. Gen Hosp Psychiatry 1985 Apr; 7(2): 149–55.CrossRefGoogle Scholar
9.Tansella, M, Micciolo, R. Unplanned first contact as a predictor of future intersive use of mental health services. Soc Psychiatry Psychiatr Epidemiol 1998; 33: 174–80.CrossRefGoogle Scholar
10.Muijen, M, Marks, I, Connolly, J, Audini, B. Home based care and standard hospital care for patients with severe mental illness. BMJ 1992; 304: 749–54.CrossRefGoogle ScholarPubMed
11.Stein, LJ, Test, MA. Alternative to mental hospital treatment. Arch Gen Psychiatry. 1980; 37: 392–7.CrossRefGoogle ScholarPubMed
12.Hoult, J, Reynolds, I, Charbonneau-Powis, M, Weekes, P, Briggs, J. Psychiatric hospital versus community treatment. Aust N Z J Psychiatry 1983; 17: 160–7CrossRefGoogle ScholarPubMed
13.Creed, F, Black, D, Anthony, Pet al.Randomised controlled trial of day and inpatient psychiatric treatment 2: comparison of two hospitals. Br J Psychiat 1991; 158: 183–9.CrossRefGoogle ScholarPubMed
14.Creed, F, Black, D, Anthony, Pet al.Randomised controlled trial of day patient versus inpatient psychiatric treatment. BMJ. 1990; 300: 1033–7CrossRefGoogle ScholarPubMed
15.Oiesvold, T, Saarento, O, Sytema, Set al.The Nordic comparative study of sectorised psychiatry – length of inpatient stay. Acta Psychiatr Scand 1999; 100: 228–9.CrossRefGoogle Scholar
16.Collins, MN, Burns, T, Van den Berk, PAH, Tubman, GF. A structured programme for out-patient alcohol detoxification. Br J Psychiat 1990; 156: 871–4.CrossRefGoogle ScholarPubMed