Academic journal article Hong Kong Journal of Psychiatry

Determinants of Length of Stay in a General Hospital Psychiatric Unit in Hong Kong

Academic journal article Hong Kong Journal of Psychiatry

Determinants of Length of Stay in a General Hospital Psychiatric Unit in Hong Kong

Article excerpt

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Introduction

Inpatient stays in psychiatric hospitals are longer than those seen in all other specialties. Since inpatient stay is usually the most expensive aspect of patient care, (1) an understanding of the determinants of inpatient stay can help to better predict the length of stay (LOS). This may, in turn, improve budgeting and management of healthcare costs. Previous studies have demonstrated the role of a number of clinical determinants in the LOS in psychiatric hospitals. While some studies found that older patients are more prone to stay longer, (2-8) one study found that those in the extreme age-groups (under 20 and over 60 years of age) were more susceptible. (9) Numerous studies have found that unmarried patients, (5,9-13) and those living alone (1,14) or not living with family, (10) have longer LOS. One study reported that male patients left hospital earlier than female patients. (11) Migrant status was associated with shorter LOS in one German study (15) while unemployment and lower educational level are associated with longer hospitalisation. (5,9,11)

Psychiatric diagnosis has been the most extensively studied variable that affects LOS. Schizophrenia, mood disorders, and learning disabilities predict longer LOS in many studies (1,3,6,15-17) while adjustment disorders18,19 and personality disorders predict shorter LOS. (6,18) Depression, dementia, and organic disorders predict longer LOS in psychogeriatric populations. (9,20) Patients with co-morbid psychiatric diagnoses are discharged earlier than those with a single diagnosis. (15) Some studies have found, however, that psychiatric diagnosis alone is not a good predictor of LOS. (21,22) Substance and alcohol abuse was consistently associated with shorter LOS in many studies. (3,4) A history of violence and self-harm was found to be an important predictor of a longer LOS. (23) Some treatment factors have been investigated. Electro-convulsive therapy treatment during hospitalisation predicted a longer LOS. (1,2,24) One study reported that clozapine treatment is associated with a decrease in hospital bed-days among patients with chronic schizophrenia. (25) Patients with chronic medical illnesses tend to stay longer. (10,26) The impact of a physical illness on LOS (usually making them tend to stay longer) is particularly strong in depressed patients. (27,28) A multiplicity of previous psychiatric admissions is associated with an increased LOS in many studies (2,3,14,29) but one showed that patients with fewer previous admissions stayed longer. (5) Duration of the previous admission correlates positively with LOS (12) and the number of inter-disciplinary consultations for nonpsychiatric health problems during hospitalisation also correlate positively with LOS. (2,24)

Problems with aftercare and living arrangements accounted for a long LOS in some studies. (30) Some patients lose their abode during the acute illness and finding suitable placements for them often takes a long time. (31) Therefore, the availability of strong step-down programmes, day hospitals, and outreach programmes facilitate shorter LOS. (32-34) Some clinical administrative indicators have been shown to correlate with LOS. For instance, 'circumstance on admission' (i.e. who accompanied the patients on admission) is a significant determinant of LOS. Patients not accompanied by anyone on admission stayed longer. (14) Voluntary patients stay for shorter periods11 while patients admitted under compulsory orders stay longer. (2) Some studies have shown that brief admissions lead to frequent readmissions (35,36) but a recent systematic review asserted that a planned short-stay policy does not encourage a 'revolving door' pattern of admission for people with serious mental illness. (37) Mattes (38) also found that a longer LOS did not decrease subsequent readmissions, improve social adjustment, or decrease psychopathology. There is a paucity of data on the clinical determinants of LOS in Chinese populations. …

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