Long and Short Stay Patients in a Hong Kong Psychiatric Day Hospital

Article excerpt

SUMMARY

The present study tried to compare the various socio-demographic and clinical data between the short-stay and the long-stay psychiatric day patients of a district general hospital. The results showed that there were not much differences in many sociodemographic and clinical factors, but the long stay ones were usually unmarried and more were transferred to other units for management upon discharge from the day hospitals. Explanations for such negative findings were discussed which called for attention to other more important determinants of hospital stay.

Keywords: length of stay, day hospital, determinants

INTRODUCTION

Psychiatric day hospitals had been in existence for many years (Mak, 1994), but not all patients would benefit from the services they provide. Many patients left after a trial of a short stag, while others were kept there for very long period. Then there is those who stayed for an intermediate period of time. So far there has been no study compared these different groups of patients. In fact, Gath et al (1973) found that patients attending traditional large mental institutions in Birmingham in the United Kingdom were older, more severe diseases, greater morbidity. McGrath & Tantam (1987) also did a similar comparison in south Manchester, but the results were rather negative, except for the quantity of previous hospital treatment.

Despite the current trend to return these patients as soon as possible into the community, there is no standard reference about the appropriate duration of hospital stay for such patients. Overseas references, e.g. the "predetermined length of stay" of the Professional Standards Review Organisation in the United States of America (Root, 1975), are not useful because there are socio-cultural factors which influence the duration of hospitalisation e.g. the attitude of Chinese families towards mental illness, the availability of other community support, etc. On the other hand, there are occasions when some doctors have kept their patients too long without real medical reasons rather than to play safe through prolonged observation, or even to suit their working schedules. This could be a wastage of hospital resources, but there is a need to evaluate this clinical aspect of the individual doctor.

An analysis of the length of stay (LOS) issue in Hong Kong may be of interest in delineating what sort of patients may benefit more from the day hospital service. It w assist in the planning of services and can alert the clinicians as to which sorts of patients will benefit from such service.

However, it must be stated here that LOS is subjected to quite a number of variable factors some of which cannot be controlled by the clinicians e.g. change of hospital admission policy or charges, staff deployment, etc.

OBJECTIVES

The objectives of the present report are twofold, viz.:

1. To record the various sociodemographic and basic clinical data of psychiatric day-patients of a district general hospital.

2. To compare the various data between the short stay groups, using the [x.sup.2] for non-continuous variables and the Pearson correlation coefficients for continuous variables.

METHODOLOGY

This is a retrospective analysis of patient records of all the 153 patients discharged during the 3 year period of 1991-1993 from the day hospital of the Psychiatric Department of the University of Hong Kong located within the Queen Mary Hospital which provided 20 day-hospital beds or better called places. The day-hospital usually admits patients with chronic psychiatric illness for rehabilitation under the care of a multidisciplinary team. Similar to U.K. centres, a full range of occupational, social and recreational activities we offered. The patients were all adult patients usually between the age of 18 to 65.

The length of stay war, calculated from the dates of admission and discharge from the day hospital concerned (Lwanga & Tye, 1986). …