Academic journal article The Israel Journal of Psychiatry and Related Sciences

Effect of Transfer of Long-Stay Psychiatric Inpatients from Hospital to Hospital/Discussion

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Effect of Transfer of Long-Stay Psychiatric Inpatients from Hospital to Hospital/Discussion

Article excerpt

Abstract: Background: Chronic psychiatric patients hospitalized in institutions about to be closed are not always fit to be transferred to community-based facilities. The purpose of our study was to investigate how the mental health of a group of such patients was affected by their being transferred to another hospital. Methods: 202 patients were evaluated prior to transfer and six months after the transfer, by means of the Clinical Global Impression (CGI), the World Health Organization (WHO) Disability Scale and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). Results: On the CGI, half the patients showed evidence of improvement while only 4% seemed to deteriorate. For the NOSIE and WHO Disability Scale, improvement of scores was similarly more common than deterioration. Factors that correlated with improvement included male sex, younger age, and a shorter hospital stay. Limitations: This is a naturalistic study of the effects of transfer which does not include a control group. Conclusion: Institutional transfer of psychiatric patients can be carried out without harm to the patient's welfare, and may even be beneficial.

Introduction

The trend towards deinstitutionalization has featured an impressive reduction in psychiatric inpatient beds in much of the Western world over the past few decades (1). Israel, too, has seen its psychiatric bed capacity decline from 2.7 per 1,000 general population in 1974 to under 1.0 today (2). However, even the most ambitious programs promoting hospital closure find a kernel of long-stay patients that are not suitable for relocation to the community (3). These patients often remain in their inpatient facility or, if that is not possible because of closure, are transferred to a different hospital.

The effect upon the patient of the latter eventuality - transfer from one inpatient institution to another - has not been well studied. Therefore, when the 1994 closure of a psychiatric hospital in Israel required finding a new institutional inpatient home for over 200 of its chronic inpatients, we decided to study their fate over time at their new address.

In Israel, most of the 5,000 psychiatric beds are owned and run by the Ministry of Health, while about a quarter are privately owned (2). Some of the latter, which treat almost exclusively chronic patients, have no acute admissions and are more poorly staffed, have been the primary target of hospital closings. The closing of one such hospital provided the setting for this study.

The purpose of the present prospective, naturalistic study was to determine if the transfer of psychiatric patients from one hospital to another could lead to beneficial or detrimental changes in the patients' wellbeing. We also wanted to investigate what psychiatric or demographic factors might predict an eventual benefit from transfer.

Methods

Patient population: Of 250 patients institutionalized in a psychiatric hospital which was to be converted to a facility for the care of the mentally handicapped, 202 patients were assessed by the treating staff as requiring continued psychiatric hospitalization, and were transferred to 12 psychiatric hospitals throughout the country.

Hospitals receiving the transferred patients:

Of the 12 hospitals to whom patients were transferred, five were government hospitals and seven were privately run hospitals. These hospitals were chosen on the basis of availability of beds, of the patients' personal preference and, when applicable, of geographical proximity to the patients' families, so that the families could visit more freely and even receive the patients for brief vacations when possible. Most patients (85%) were transferred to private hospitals.

Data collection: Patients were evaluated prior to discharge from the old hospital and subsequently six months after admission to the new. A special research staff not involved in the treatment conducted both evaluations. …

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