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Measuring the distribution of the length of stay in acute psychiatric units

Published online by Cambridge University Press:  05 August 2011

Matthew M. Large ,
Michael B. Paton ,
Grant Sara ,
Murray Wright  and
Olav B. Nielssen
Matthew M. Large*
Affiliation:
Psychiatrist and Conjoint Senior Lecturer, School of Psychiatry, University of New South Wales, Sydney, Australia
Michael B. Paton
Affiliation:
Clinical Director, Mental Health Drug and Alcohol, Northern Sydney Local Hospital Network & Central Coast Local Hospital Network, Macquarie Hospital, Sydney, Australia
Grant Sara
Affiliation:
Director, InforMH, Mental Health and Drug and Alcohol Office, NSW Health, North Ryde, Australia Clinical Senior Lecturer, Northern Clinical School, Sydney University, Australia School of Population Health, University of Queensland, Australia
Murray Wright
Affiliation:
Formerly Director, Clinical Operations, Mental Health Drug and Alcohol, Greater Southern Area Health Service, NSW, Australia
Olav B. Nielssen
Affiliation:
Psychiatrist and Conjoint Senior Lecturer, Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Sydney, Australia
*
Correspondence to: Matthew Large, The Euroa Building, Prince of Wales Hospital, Barker St, Randwick, New South Wales, Australia, 2031. E-mail: mmbl@bigpond.com
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Abstract

Objective: To examine the distribution of length of stay (LOS) in acute psychiatric units.

Method: Analysis of one year of LOS data from twelve acute psychiatric units in New South Wales, Australia.

Main findings: LOS had a complex distribution, with a ‘head’ of discharges within a day, a ‘body’ of discharges that approximated an exponential distribution and a ‘tail’ made up of a small group of patients discharged after very long admissions. There were substantial differences between units in the proportions of discharges classified as being in the head and the tail of the LOS distribution. With regards to the traditional measures of central tendency, the median LOS was affected by the proportion of patients discharged within a day, and the mean LOS was strongly influenced by small numbers of very long stay patients.

Conclusions: A graphic representation of logarithmically transformed LOS values might assist in understanding the LOS of individual acute psychiatric units. A modified median LOS, calculated after the removal of patients staying less than a day, was found to be a simple and reliable measure that can potentially provide a more meaningful measure of LOS than the mean or the median LOS.

Keywords

Length of staypsychiatric hospital
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 8 , Issue 2 , August 2012 , pp. 78 - 87
Copyright
Copyright © NAPICU 2011

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References

Brakoulias, V., Mandali, R., Seymour, J., Sammut, P.and Starcevic, V. (2010) Characteristics of admissions to a recently opened Psychiatric Emergency Care Centre. Australasian Psychiatry. 18(4): 326–329.CrossRefGoogle ScholarPubMed
Caton, C.L. and Gralnick, A. (1987) A review of issues surrounding length of psychiatric hospitalization. Hospital and Community Psychiatry. 38(8): 858–863.Google ScholarPubMed
Creed, F., Tomenson, B., Anthony, P. and Tramner, M. (1997) Predicting length of stay in psychiatry. Psychological Medicine. 27(4): 961–966.CrossRefGoogle ScholarPubMed
Delucchi, K.L. and Bostrom, A. (2004) Methods for analysis of skewed data distributions in psychiatric clinical studies: working with many zero values. American Journal of Psychiatry. 161(7): 1159–1168.CrossRefGoogle ScholarPubMed
Forero, R., Hillman, K.M., McCarthy, S., Fatovich, D.M., Joseph, A.P. and Richardson, D.B. (2010) Access block and ED overcrowding. Emergency Medicine Australasia. 22(2): 119–135.CrossRefGoogle ScholarPubMed
Frick, U., Rehm, J., Frischker, S. and Cording, C. (1999) Length of stay in a German psychiatric hospital as a function of patient and organizational characteristics – a multilevel analysis. International Journal of Methods in Psychiatric Research. 8(3): 146–161.CrossRefGoogle Scholar
Hanson, B.L. (1973) A statistical model for length of stay in a mental hospital. Health Services Research. 8(1): 37–45.Google Scholar
Herr, B.E., Abraham, H.D. and Anderson, W. (1991) Length of stay in a general hospital psychiatric unit. General Hospital Psychiatry. 13(1): 68–70.CrossRefGoogle Scholar
Hudson, C.G. (2004) Trends in acute psychiatric inpatient care in Massachusetts. Psychiatric Services. 55(11): 1302–1304.Google Scholar
Huntley, D.A., Cho, D.W., Christman, J. and Csernansky, J.G. (1998) Predicting length of stay in an acute psychiatric hospital. Psychiatric Services. 49(8): 1049–1053.CrossRefGoogle Scholar
Kiesler, C.A., Simpkins, C. and Morton, T. (1990) Predicting length of hospital stay for psychiatric inpatients. Hospital and Community Psychiatry. 41(2): 149–154.Google ScholarPubMed
Large, M., Nielssen, O., Slade, T. and Harris, A. (2008) Measurement and reporting of the duration of untreated psychosis. Early Intervention in Psychiatry. 2(4): 201–211.CrossRefGoogle ScholarPubMed
Lelliott, P. and Wing, J. (1994) A national audit of new long-stay psychiatric patients. II: Impact on services. British Journal of Psychiatry. 165(2): 170–178.Google Scholar
Lelliott, P., Wing, J. and Clifford, P. (1994) A national audit of new long-stay psychiatric patients. I: Method and description of the cohort. British Journal of Psychiatry. 165(2): 160–169.CrossRefGoogle Scholar
Manning, W.G. and Mullahy, J. (2001) Estimating log models: to transform or not to transform? Journal of Health Economics. 20(4): 461–494.CrossRefGoogle ScholarPubMed
Marazzi, A., Paccaud, F., Ruffieux, C. and Beguin, C. (1998) Fitting the distributions of length of stay by parametric models. Medical Care. 36(6): 915–927.CrossRefGoogle ScholarPubMed
McCrone, P. and Phelan, M. (1994) Diagnosis and length of psychiatric in-patient stay. Psychological Medicine. 24(4): 1025–1030.CrossRefGoogle ScholarPubMed
Mechanic, D., McAlpine, D.D. and Olfson, M. (1998) Changing patterns of psychiatric inpatient care in the United States, 1988–1994. Archives of General Psychiatry. 55(9): 785–791.CrossRefGoogle ScholarPubMed
Oiesvold, T., Saarento, O., Sytema, S., Christiansen, L., Göstas, G., Lönnerberg, O., Muus, S., Sandlund, M. and Hansson, L. (1999) The Nordic Comparative Study on Sectorized Psychiatry – length of in-patient stay. Acta Psychiatrica Scandinavica. 100(3): 220–228.Google Scholar
Park, J.M., Park, L.T., Siefert, C.J., Abraham, M.E., Fry, C.R. and Silvert, M.S. (2009) Factors associated with extended length of stay for patients presenting to an urban psychiatric emergency service: a case-control study. Journal of Behavioral Health Services and Research. 36(3): 300–308.CrossRefGoogle Scholar
Priest, R.G., Fineberg, N., Merson, S. and Kurian, T. (1995) Length of stay of acute psychiatric inpatients: an exponential model. Acta Psychiatrica Scandinavica. 92(4): 315–317.CrossRefGoogle ScholarPubMed
Tulloch, A.D., Fearon, P. and David, A.S. (2008) The determinants and outcomes of long-stay psychiatric admissions: a case-control study. Social Psychiatry and Psychiatric Epidemiology. 43(7): 569–574.CrossRefGoogle ScholarPubMed