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PubMedDate not supplied

The impact of psychiatric comorbidity on length of stay of medical inpatients.

The aim of the study was to determine the impact of psychiatric comorbidity (PC) on length of hospital stay (LOS) of medical inpatients. A prospective cohort study was conducted. A series of 317 medical inpatients consecutively admitted to the general medical wards of a University Hospital composed the sample, after excluding those who refused or who could not be evaluated due to their physical illnesses or treatments (n=78). Data on demographic and medical variables were collected. A psychiatrist categorized subjects into two cohorts (with and without PC), according to DSM-IV, using the Schedule for Affective Disorders and Schizophrenia, except in patients cognitively impaired who were diagnosed by clinical interview. Mortality and length of stay during the index hospitalization were recorded. At admission, 156 (49%) inpatients had a current psychiatric comorbidity. After controlling for confounders (age and physical severity), in the multivariate analysis of covariance, the patients with cognitive impairment had a significantly prolonged LOS (F=17.8; P<.01) compared with those without cognitive impairment. No difference existed in LOS for the patients with depressive disorders (F=0.36; P=.55), Anxiety disorders (F=1.48; P=.22) or Substance related disorders (F=1.05; P=.30). These results suggest an independent effect of cognitive impairment increasing LOS of medical inpatients.

Adolescent↗
PubMed1998

A closer look at inpatient suicide.

BACKGROUND: We examined the risk factors for suicide among inpatients in an Ontario provincial psychiatric hospital. METHODS: Forty-four inpatients who had committed suicide during their hospital stay from 1969 to 1995 were compared with a group of inpatient controls matched for sex, age and date of admission. The diagnosis for each patient was reviewed by the authors. RESULTS: Suicide victims were more likely to have had a mood disorder, family history of psychiatric problems, mention of suicide risk in chart notes and a previous suicide attempt. Two findings necessitated further scrutiny: The most common diagnosis among inpatients who committed suicide in this study was a mood disorder and not schizophrenia as previously reported. A large proportion of patients (24) had experienced a rapidly fluctuating clinical course prior to the time of suicide. CONCLUSIONS: The implications of these findings, including the possible role of antidepressants in the induction of cycling prior to suicide, are discussed.

Adult↗
PubMed1999

The changing status of inpatient dermatology at American academic dermatology programs.

BACKGROUND: Changes in health care delivery financing such as the adoption of the diagnosis-related groups (DRG) in 1983 has affected inpatient services of dermatology programs across the United States. OBJECTIVE: The purpose of this study was to define the present status of inpatient dermatology at academic medical centers compared with 1982. METHODS: Questionnaires inquiring about the state of inpatient service were sent to the chairpersons of each dermatology residency program in the United States. RESULTS: Of the 71 programs responding, 79% reported a reduction in inpatient activity. Nearly half of the dermatology programs with dedicated dermatology beds in 1982 reported not continuing to have these in 1997 (41 to 24). The average number of patients admitted for skin disease decreased from 1 19 in 1982 to 36.5 in 1997, and the average daily census decreased from 8.9 to 2.2. CONCLUSION: There has been a decline in the number of patients hospitalized by academic dermatology departments and a shift of some patients hospitalized to beds where the attending is other than a dermatologist.

Academic Medical Centers↗
PubMed1983

Interdisciplinary model for the inpatient treatment of adolescents with anorexia nervosa.

This paper describes the inpatient phase of an anorexia nervosa treatment program in an adolescent unit of a children's hospital. This program focuses on four goals: improving eating behavior, improving socialization, achieving initial weight gain, and engaging the patient and her family with an outpatient psychotherapist. The patients were divided into three groups according to severity. All five Group I patients (less than 25% body weight loss) had a composite 100% achievement of the four goals. Twenty out of 21 Group II patients (greater than 25% body weight loss) had 100% achievement of the four goals. Three out of six Group III patients (greater than 25% body weight loss and requiring hyperalimentation) had 100% achievement of the four goals. The success of this inpatient program is felt to be due to the pediatric-psychiatric collaboration, the involvement of the family during the inpatient phase, the therapeutic use of an interdisciplinary team and of the social system of the inpatient unit including other patients and recreation therapist.

Adolescent↗
PubMed1997

A sociodemographic analysis of inpatient oral surgery: 1989-1994.

This retrospective study was designed to assess the socioeconomic status of patients who underwent inpatient oral operations from 1989 to 1994 in the area covered by the West Midlands Regional Health Authority and to compare the distribution with those people treated by other specialties. A total of 4,926,438 hospital inpatient finished consultant episodes within 56 specialties that were recorded on the Hospital Episode Statistics database, of which 61,360 (1.25%) were dental (coded as oral surgery, restorative dentistry, orthodontics, and paediatric dentistry). The main outcome measure was the socioeconomic status of patients as assessed by the Townsend score (a measure of material deprivation that covers car ownership, home ownership, overcrowding, and unemployment). There was a highly significant correlation between the use of all inpatient services and social deprivation (R2 = 0.98, P < 0.001). This observation was consistent across all specialties except oral surgery, in which the correlation was reversed (R2 = 0.69, P < 0.001), indicating that patients who avail themselves of inpatient oral surgery are from a higher socioeconomic group. The application of a deprivation index to hospital episode data will enable purchasers and providers to measure more accurately the impact of their services on groups within the community.

Automobiles↗
PubMed2003

The influence of distance on utilization of outpatient mental health aftercare following inpatient substance abuse treatment.

This study examined whether substance abuse patients who live farther from their source of outpatient mental health care were less likely to obtain aftercare following an inpatient treatment episode. For those patients who did receive aftercare, distance was evaluated as a predictor of the volume of care received. A national sample of 33,952 veterans discharged from Department of Veterans Affairs (VA) inpatient substance abuse treatment programs was analyzed using a two-part choice model utilizing logistic and linear regression. Patients living farther from their source of outpatient mental health care were less likely to obtain aftercare following inpatient substance abuse treatment. Patients who traveled 10 miles or less were 2.6 times more likely to obtain aftercare than those who traveled more than 50 miles. Only 40% of patients who lived more than 25 miles from the nearest aftercare facility obtained any aftercare services. Patients who received aftercare services had fewer visits if they lived farther from their source of aftercare. Lack of geographic access (distance) is a barrier to outpatient mental health care following inpatient substance abuse treatment, and influences the volume of care received once the decision to obtain aftercare is made. Aftercare services must be geographically accessible to ensure satisfactory utilization.

Adult↗
PubMed2000

Inpatient dermatology. United Kingdom and United States similarities: moving with the times or being relegated to the back bench?

Financial and managerial pressures have resulted in the rationalization of inpatient dermatology beds in the United Kingdom. Although these two countries have different populations and health care systems, both have been subject to similar drives toward cost containment. Advances in dermatology have broadened the reach of outpatient-based dermatological care that provides for most skin patients; however, inpatient treatment remains an important and essential therapeutic option for a group of patients. Dermatologic inpatient care may be inadequately and inefficiently provided by nondermatologists. It is important to ensure that the quality of dermatology inpatient services is maintained at the highest standard while using, and working within, a constantly evolving system of health care. Only then can dermatologists tailor the specialty to maximize the benefits for the patients and the profession as a whole.

Delivery of Health Care↗
PubMed1997

Pursuit of the ordinary: short-term inpatient treatment.

Short-term inpatient care creates tension between administrative mandates to reduce costs through shortened lengths of stay and staff members' commitment to the philosophy, treatment strategies, and milieu organization associated with extended inpatient care. The attempt to practice as usual within the shortened stay, that is, to do long-term treatment quickly, is bound to fail. Effective short-term care is possible, but only when the culture and treatment approach of the unit are radically altered from those of the traditional model. Short-term inpatient treatment can be understood as the pursuit of ordinary behavior during the inpatient stay. This article offers a set of norms and expectations appropriate for this pursuit.

Adolescent↗
PubMedDate not supplied

Continuous quality improvement project: decreasing the potential for the development in the inpatient setting of drug resistance by improving nursing practice for HAART administration.

HIV/AIDS patients' dissatisfaction with highly active antiretroviral therapy (HAART) medication administration in the inpatient setting was the impetus for a continuous quality improvement (CQI) project. The purpose of the CQI project was to initiate a change in nursing practice for HAART medication administration. The goal of the project was to decrease the potential for development of drug resistance in the inpatient setting related to nonadherence with food requirements for drug administration and to incomplete or "missed" doses of prescribed HAART. A secondary goal was to increase the provision of patient education on HAART medications by nurses. The interdisciplinary CQI team found that medication administration in the inpatient setting involved more than nurses simply "passing meds." Inpatient medication administration was a complex process involving a variety of hospital systems, departments, and traditions, all of which had an impact on patient care. The article describes the CQI methodology that was used for the project and how each step of the project was planned and implemented. Specific problems related to administering HAART in the hospital setting are listed as areas for needed nursing research.

Anti-HIV Agents↗
PubMed2001

Exercise and eating disorders: a 3-year inpatient hospital record analysis.

The purpose of this study was to describe the exercise behavior across the DSM-IV eating disorder diagnosis (anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS)) and determine if differences exist among exercise category (high level and low level), type of exercise (aerobic, strength, and total), Eating Attitudes Test (EAT), Eating Disorders Inventory (EDI-2), and the length of inpatient hospitalization. This study was a retrospective analysis of 199 inpatient hospital records of female patients (age M=20.6, S.D.=7.03) in the following diagnostic categories: AN (n=115, 58%), BN (n=38, 19%), and EDNOS (n=46, 23%). Patients were also grouped by a median split into low- and high-level exercise categories based on their total amount of weekly exercise. No significant relationship was found between diagnosis and exercise category (high and low) or diagnosis and exercise type (total, aerobic, and strength exercise). This is valuable because exercise specialist may be a worthwhile addition to treatment teams working with all eating disorder diagnostic groups. The high-level exercisers showed significantly greater scores on the EAT [F(2,1,110)=5.117, P<.05] and weight preoccupation [F(1,1010)=4.861, P<.05] than the low-level exercise groups. There were significant relationships between total exercise and EAT (r=.354, P<.01), drive for thinness (r=.262, P<.01), and body dissatisfaction (r=.312, P<.001). Total aerobic exercise was significantly related to EAT (r=.352, P<.001), drive for thinness (r=.272, P<.01), and body dissatisfaction (r=.268, P<.01). Finally, total strength exercise was related to body dissatisfaction (r=.249, P<.05). A significant difference was found among exercise group and length of hospitalization [F(1,155)=14.384, P<.000]. The high-level exercisers were in treatment for 3 weeks longer than their low-level exercisers. A forced stepwise multiple linear regression was calculated to predict the length of hospitalization. At Step 1, diagnosis and Body Mass Index (BMI) on admission explained 27% of the variance in length of inpatient hospitalization [F(4,154)=18.08, P<.004, r(2)=.273]. When two exercise variables were included, aerobic activity explained an additional 5% of variance, whereas strength activity explained an additional 0.3% of the variance. Three-fourths of the predictors explained significant components of the total 32% variance. The present study demonstrates that patients with greater total exercise and a greater total aerobic exercise show a significantly greater drive for thinness and require a longer length of hospitalization. This association was not present with total strength exercise levels. Effective clinical methods to modify total aerobic exercise levels need to be determined with inpatient populations.

Journal Article↗
PubMedDate not supplied

Acute inpatient psychiatry in England: an old problem and a new priority.

With the development of community care, the number of National Health Service psychiatric beds in England has been reduced to between one-fifth and one-quarter of those provided in the mid-1950s. Psychiatric bed numbers are close to the irreducible minimum if they have not already reached it. The problems facing today's acute psychiatric admission wards include: poor design, maintenance and ambience; a lack of therapeutic and leisure activities for patients leading to inactivity and boredom; frequent incidents of aggression and low-level violence and problems with staffing. It is suggested that there are a number of underlying causes: First, there has been failure to plan inpatient services, or to define their role, as attention has focused on new developments in community care. Second, the reduction in bed numbers has led to a change in the casemix of inpatients with a concentration on admission wards of a more challenging group of patients. Third, admission ward environments are permeable to the adverse effects of local street life, including drug taking. After years of neglect, acute inpatient psychiatric services in England are now high on the UK Government agenda. The paper lists a number of national initiatives designed to improve their quality and safety. A recent review of qualitative research suggests that acute psychiatric wards in other countries face similar problems to those reported in England. It is suggested that there might be a need for joint action which might take the form either of international research about acute inpatient care or the development of international standards and a common quality improvement system.

Acute Disease↗
PubMed2001

The application of dialectical behavior therapy for patients with borderline personality disorder on inpatient units.

Inpatient treatment of individuals with borderline personality disorder (BPD) is typically fraught with difficulty and failure. Patients and staff often become entangled in intense negative therapeutic spirals that obliterate the potential for focused, realistic, and effective treatment interventions. We describe an inpatient treatment approach to BPD patients which is an application of Dialectical Behavior Therapy (DBT), a cognitive-behavioral therapy for patients with BPD which has been shown to be effective in reducing suicidal behavior, hospitalization, and treatment dropout and improving interpersonal functioning and anger management. The inpatient DBT staff creates a validating treatment milieu and focuses on orienting and educating new patients and identifying and prioritizing their treatment targets. Inpatient DBT treatment techniques include contingency management procedures, skills training and coaching, behavioral analysis, structured response protocols to suicidal and egregious behaviors on the unit, and consultation team meetings for DBT staff.

Borderline Personality Disorder↗
PubMed2002

Violence in a general hospital: comparison of assailant and other assault-related factors on accident and emergency and inpatient wards.

OBJECTIVE: This study sought to compare the characteristics of aggressive incidents occurring on inpatient (medical and surgical) wards with those occurring in the accident and emergency department in terms of assailant, employee and other factors. METHOD: A prospective interview-based survey design was adopted. Forty-eight assaulted staff were interviewed about 69 incidents within 7 days on average of the incident occurring. The presence or absence of various assailant, employee, situation, interaction and outcome factors derived from the UK Health Services Advisory Committee's model was compared between the two settings. RESULTS: Inpatient ward incidents were significantly more likely to have the following characteristics: female perpetrator, perpetrator aged over 70 years, daytime occurrence in a restricted area, resolved by support from other health care staff. CONCLUSION: Aggression frequently occurs on inpatient (medical and surgical) wards of a general hospital. Aggression management training for staff working in both accident and emergency and inpatient settings should be cognisant of the similarities and differences within general health care specialisms.

Cognition Disorders↗
PubMed2000

Treatment settings for persons with alcoholism: evidence for matching clients to inpatient versus outpatient care.

This study compared inpatient, intensive outpatient, and standard outpatient treatment settings for persons with alcoholism and tested a priori hypotheses about the interaction of setting with client alcohol involvement and social network support for drinking. Participants (N = 192) were assigned randomly in cohorts to 1 of the 3 settings. The settings did not differ in posttreatment primary drinking outcomes, although inpatients had significantly fewer jail and residential treatment days combined than outpatients. Clients high in alcohol involvement benefited more from inpatient than outpatient care; the opposite was true at low alcohol involvement levels. Network drinking support did not moderate setting effects. Clients low in cognitive functioning also appeared to benefit more from inpatient than outpatient care. Improved outcomes might be achieved by matching degree of alcohol involvement and cognitive functioning to level of care.

Adult↗
PubMed2004

Clinical and economic outcomes of preterm labor management: inpatient vs outpatient.

OBJECTIVE: To compare pregnancy and economic outcomes in women receiving inpatient vs outpatient tocolysis with continuous subcutaneous terbutaline (SQT). STUDY DESIGN: Identified within a database were women prescribed SQT at 24.0 to 33.9 weeks' gestation following stabilization of an acute episode of preterm labor. Women with cervical dilatation >3 cm, and/or maternal or fetal instability were excluded. Those with prolonged inpatient care were matched 1:1 to those discharged with outpatient follow-up by cervical dilatation, gestational age, and fetal number yielding 90 matched pairs (180 women). RESULTS: Inpatients had an earlier gestational age at delivery (34.1+/-2.9 vs 35.8+/-1.9 weeks, p<0.001), higher preterm birth rate (86.7% vs 74.4%, p=0.043) and higher overall costs (56,089 dollars+/-47,944 dollars vs 25,540 dollars+/-25,847 dollars, p<0.001) than outpatients. CONCLUSION: Outpatient management resulted in improved pregnancy outcomes at a cost less than that of inpatient management in this analysis of women treated with SQT.

Adult↗
PubMed2003

An evaluation of the Dartmouth Assessment of Lifestyle Inventory and the Leeds Dependence Questionnaire for use among detained psychiatric inpatients.

AIM: To examine the psychometric properties of the Dartmouth Assessment of Lifestyle Inventory (DALI) as a substance use disorder screening instrument, and the Leeds Dependency Questionnaire (LDQ) as a measure of severity of dependence among inpatients with severe mental disorders detained in hospital. DESIGN: Comparison of DALI scores, LDQ scores and a clinical assessment of substance use disorder. Statistical analysis calculated Cronbach's alpha, receiver operator characteristics, anova and multivariate linear regression. SETTING: An English medium secure psychiatric hospital. PARTICIPANTS: A random sample of 60 adult inpatients with one or more diagnoses of schizophrenia, personality disorder and mild to moderate learning difficulty. MEASUREMENTS: All participants completed the LDQ, DALI and a clinical assessment of substance use disorder using ICD-10 criteria. FINDINGS: The diagnostic accuracy of the DALI instrument was 74% for alcohol disorders and 83% for drug disorders. The reliability of the LDQ and concurrent validity with the DALI were good (a = 0.915, R2 = 0.439, F (2, 57) = 22.3, P < 0.001). CONCLUSIONS: The DALI's overall accuracy for screening inpatients is good, but it under-diagnosed substance use disorders, probably because the hospital environment moderates substance use. The results suggest that the LDQ has very good psychometric properties and is useful as a measure of substance dependence in this population. Furthermore, the validity of the LDQ in this clinical population provides evidence to suggest the same cognitive and behavioural processes of addiction operate among those inpatients with severe mental disorders detained in psychiatric hospital as in the general population.

Adult↗
PubMed2002

The content of management of violence policy documents in United Kingdom acute inpatient mental health services.

AIM OF THE STUDY: The aim of the study was to examine the content of Trust policies concerning the prevention and management of violence in acute in-patient settings in order to establish their usefulness as guidance for staff in this difficult, complex, and controversial aspect of inpatient psychiatric care. BACKGROUND: Violence is a commonly encountered problem in inpatient psychiatric settings. There are legal requirements for workplaces in general and mental health care facilities in particular to develop safe systems of work based upon the findings of assessments of this risk. Policies have a key role to play in making explicit the responsibilities of both employer and employees, and specifying standards of acceptable practice. DESIGN: A cross-sectional survey methodology was used, which entailed examination of the content of management of violence policies that had been forwarded to the authors from 40 Trusts providing acute inpatient psychiatric care throughout England, Scotland, Wales, and Northern Ireland. FINDINGS: Policies were found to vary widely in their content, and serious shortcomings were noted in the extent to which policies included information regarding their status and review, advice on the prevention of violence, the management of violent incidents, and postincident action. CONCLUSIONS: Further research is needed to tease out the extent to policies which are lacking in content, reflect shortcomings in the organizational approach to the prevention and management of violence by Trusts, and the extent to which such shortcomings result in harm being suffered by staff and/or patients. An alternative format for the presentation of management of violence policies is discussed, and items that should be included in inpatient units' management of violence policies are suggested.

Cross-Sectional Studies↗
PubMed2003

Two-year follow-up of a randomized controlled trial of a clinical nurse specialist intervention, inpatient, and day patient team care in rheumatoid arthritis.

AIM: To compare the long-term effectiveness of care delivered by a clinical nurse specialist (CNS) with inpatient team care and day patient team care in patients with rheumatoid arthritis and increasing functional limitations. Background. The role of CNSs in the management of patients with rheumatoid arthritis (RA) is evolving, and their effectiveness in comparison with care provided by a rheumatologist alone has been established. However, long-term controlled studies showing how the effectiveness of CNSs compares with that of other forms of co-ordinated care, such as multidisciplinary team care, are lacking. METHODS: Two hundred and ten patients rheumatoid arthritis patients were randomized to care delivered by a CNS in a rheumatology outpatient clinic (12 weeks), inpatient team care (2 weeks) and day patient team care (3 weeks). Clinical assessments recorded on study entry, weeks 12, 26, 52, 78 and 104 comprised the health assessment questionnaire (HAQ) and MacMaster Toronto Arthritis (MACTAR) patient preference interview as primary outcome measures. Grip strength, walk test, RAND-36, Rheumatoid Arthritis Quality of Life questionnaire and disease activity score (DAS) were applied as secondary outcome measures. RESULTS: No significant differences in medical treatment, use of services of other health professionals, introduction of adaptive equipment or number of hospitalizations were observed between the three treatment groups during 2 year follow-up, except that visits to nurse specialists were more frequent and home help was less frequent in the CNS group. A comparison of clinical outcomes among the three groups and a comparison between the nurse specialist and inpatient and day patient care groups together did not show any significant differences. Within all three groups functional status, quality of life and disease activity improved significantly (P < 0.05). In general, the results obtained after 12 weeks remained stable until 104 weeks after the start of the study. CONCLUSION: Care provided by a CNS in an outpatient rheumatology clinic has a similar long-term clinical outcome to inpatient and day patient team care in patients with rheumatoid arthritis. A CNS intervention appears to be an effective innovation in the care for patients with rheumatoid arthritis.

Adult↗