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PubMed2002

Enhancing Continuity of Care: Residency Training in an Integrated Inpatient--Partial Hospital Program.

This paper describes a teaching/service model that integrates inpatient, partial hospital, and intensive outpatient treatment. In this model, individual multidisciplinary treatment teams retain responsibility for a patient's care for any or all of three levels of intensity of services accessed during an episode of illness. This teaching/service model allows residents to follow patients for an average of 2.5 weeks across an entire acute episode of care compared with the 7.3 days of the average inpatient stay at the inpatient facility. The opportunity to continue treatment in step-down settings over longer periods of time allows residents and medical students to develop a fuller understanding of their patients. The authors believe that this continuum-care service model more efficiently trains residents in multiple aspects of psychiatric practice and provides patients with better care than the traditional inpatient-care service model.

Journal Article↗
PubMed2001

An emergency housing program as an alternative to inpatient treatment for persons with severe mental illness.

OBJECTIVE: This study evaluated the feasibility and effectiveness of an emergency housing program as a step-down program after inpatient care, as a step-up program from community-based living, and as an alternative to inpatient care for individuals with serious mental illness who sought treatment at an urban medical center. METHODS: One hundred sixty-one persons admitted consecutively to an emergency housing program were assessed retrospectively with the Severity of Psychiatric Illness scale and the Acuity of Psychiatric Illness scale at admission and again at discharge. Analyses of covariance were used to evaluate the change in residents' clinical acuity and psychosocial status between admission and discharge. RESULTS: Residents who had been admitted to the emergency housing program from inpatient psychiatric treatment showed a significant decline in acuteness of psychiatric symptoms. Psychiatric symptoms also improved for residents who were admitted to the program from community-based service programs and for residents admitted as an alternative to inpatient treatment, although the differences for these two groups were less prominent. CONCLUSIONS: The findings suggest that an emergency housing program is a feasible mode of extended community-based care for many persons with serious and persistent mental illness.

Acute Disease↗
PubMed2004

Psychosocial risk factors associated with suicide attempts and violence among psychiatric inpatients.

OBJECTIVES: To better understand the relationship between suicidal behavior and violence directed toward others among patients with major psychiatric disorders, this study examined how suicide attempts and violent behaviors were associated with various psychosocial problems. METHODS: Participants were inpatients in two psychiatric state hospitals. They included 216 inpatients who had physically assaulted another patient or a staff member and a comparison group of 81 inpatients who had not assaulted anyone. History of suicide attempts and historical information about various risk factors for violence and suicide were obtained through chart review and patient interviews. RESULTS: Patients in the violent group did not differ from those in the nonviolent group in whether they had attempted suicide. Suicide attempts and violence were associated with different historical variables. Suicide attempts were associated with a history of head trauma, harsh parental discipline, and parental psychopathology. Violence against others was associated with having a history of school truancy and foster home placement. CONCLUSIONS: Among inpatients with major psychiatric disorders, violence and suicide attempts were not related to each other and were associated with dissimilar psychosocial risk factors.

Adolescent↗
PubMed2005

Effects on processes and costs of care associated with the addition of an internist to an inpatient psychiatry team.

OBJECTIVE: This study examined the effects of collaboration between an internist and psychiatrists on the processes and cost of care among psychiatric inpatients. METHODS: A randomized controlled study was performed on the psychiatric inpatient units of an academic medical center. All inpatients who were admitted to the units between March 2001 and January 2002 were asked to participate in the study. Patients in the intervention group met with an internist who participated in their care by communicating with the patients' primary care physicians, assessing needs, updating appropriate health maintenance services, managing chronic and acute medical problems, and attending hospital work rounds. Patients in the usual-care group received usual care. The processes of care were measured by examining 17 categories that involved assessment of needs, coordination of care, and completion of health maintenance services. Resource use was measured by examining hospital charges and length of stay. RESULTS: A total of 139 adults participated in the study: 55 were in the intervention group and 84 were in the usual-care group. Patients in the intervention group showed significant improvement in 12 of the 17 categories of the processes of care. Overall, no differences were found in hospital charges or length of stay. CONCLUSIONS: Adding an internist to an inpatient psychiatric team is an effective way of improving care for this traditionally underserved population without increasing cost.

Academic Medical Centers↗
PubMed1997

Incidence of extrapyramidal syndromes in AIDS patients and a comparison group of medically ill inpatients.

The authors retrospectively reviewed the charts of 29 inpatients with AIDS and 24 medically ill inpatients, all of whom were exposed to neuroleptics. Results adjusted for age, gender, type and dosage of neuroleptic, and extrapyramidal prophylaxis indicated that inpatients with AIDS were 7 times more likely to develop extrapyramidal syndromes (EPS) from neuroleptics than the comparison group of medically ill inpatients. Possible neuroanatomic, neuropathologic, and neurochemical reasons for the vulnerability of patients with AIDS to EPS are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed1982

The neglected alliance: the inpatient unit as a consultant to referring therapists.

During two years of work on an inpatient psychiatry unit in a general hospital, the authors became impressed with how often patient-therapist difficulties preceded the need to hospitalize a patient. Difficulties in the therapeutic relationship sometimes precipitated the hospitalization; other times they were complicating factors. Unresolved difficulties in this relationship had to be addressed during hospitalization if inpatient treatment was to be successful. The authors present several typical cases that demonstrate different kinds of difficulties in the patient-therapist relationship and the use of consultation by an inpatient staff in resolving them. They conclude that an inpatient unit with sufficient staff should serve as a consultant to the referring therapist in almost every case.

Adult↗
PubMed1988

Inpatient and outpatient psychiatric services: substitutes or complements?

Patients at risk for psychiatric hospitalization make only limited use of outpatient services, although clinical research has demonstrated that outpatient treatments and home care can be as effective as inpatient psychiatric treatment in treating certain mental health problems. The substitution of ambulatory services for inpatient care has in part been limited because insurers have restricted outpatient mental health benefits to control utilization. The authors critically review evidence from the economic and clinical literatures to determine the extent to which outpatient psychiatric treatment substitutes or complements inpatient treatment. To encourage clinically effective substitution of outpatient for inpatient services, further research is needed to identify the patient populations for whom substitution is possible and the treatment and environmental conditions in which it is most likely to be successful.

Ambulatory Care↗
PubMed1993

Projections of inpatient admissions to specialty mental health organizations: 1990 to 2010.

OBJECTIVE: To help predict changes in patterns of service delivery, the total number of inpatient admissions to specialty mental health organizations and the number of elderly persons (over age 65) admitted were projected in five-year intervals between 1990 and 2010. METHODS: One set of projections is based on 1986 rates of use and their coefficients of variation. A second, more accurate, set is based on 1990 rates derived from logarithmic projections of trends from 1980 to 1986 and the coefficients of variation for the 1986 rates. RESULTS: Projections based on 1990 rates show an increase of more than 25 percent in the total number of inpatient admissions to all specialty mental health organizations between 1986 and 2010 and an increase of more than 40 percent in elderly admissions. Nonfederal general hospitals are expected to have the largest increases in the number of total admissions, and state and county mental hospitals the smallest. The greatest percentage growth in total admissions will occur in private psychiatric hospitals. For elderly persons, inpatient admissions to Veterans Affairs medical centers will show the largest percentage increase, and admissions to state and county mental hospitals the smallest. By 2010 the majority of elderly admissions (67.6 percent) will be to nonfederal general hospitals. CONCLUSIONS: Plans to cope with increased demand for inpatient services should take into account the potential economic consequences of the forecasted changes as well as their effects on allocation of and access to services.

Aged↗
PubMed1996

Deaths among former psychiatric inpatients in an outreach case management program.

OBJECTIVE: The mortality rate of discharged psychiatric inpatients has long been known to be higher than that of persons in the general population. This study assessed the effectiveness of outreach case management in reducing the mortality rate of recently discharged psychiatric inpatients in New York City. METHODS: A sample of 292 patients discharged from an inpatient psychiatry service at an urban general hospital were randomly assigned either to an intervention group (N = 147), which received intensive outreach case management for periods ranging from 15 to 52 months after discharge, or to a control group (N = 145), which received standard aftercare services. Both groups were offered and received regular aftercare and other services during the study period. Both groups were followed for comparable periods of time to determine their rate of mortality. RESULTS: The overall mortality rate for the total group of 292 patients was 7.2 percent, 2.25 times higher than among persons in the general population matched for age, sex, and race. The mortality rates for the intervention group and the control group were 7.5 percent and 6.9 percent, respectively, not a significant difference. CONCLUSIONS: Discharged psychiatric inpatients who received outreach case management did not have a lower mortality rate than similar patients who did not receive this intervention.

Adult↗
PubMed1997

Risk factors for parasuicide among psychiatric inpatients.

To improve suicide prevention during hospitalization, this study examined risk factors for parasuicide among psychiatric inpatients. A group of 58 psychiatric inpatients (19 with schizophrenia, 20 with depression, and 19 with other diagnoses) who displayed suicidal behavior during hospitalization were compared with two control groups of nonparasuicidal inpatients. For inpatients with schizophrenia, a history of parasuicide was a risk factor; for those with depression, it was suicidal behavior on admission; and for patients with other diagnoses, it was violence during hospitalization.

Adolescent↗
PubMed1998

Teaching psychiatric inpatients to re-enter the community: a brief method of improving the continuity of care.

OBJECTIVE: The study evaluated the effects of a brief manualized treatment program that taught patients skills to re-enter the community and actively follow through with their own care. METHODS: A total of 59 recently admitted inpatients with schizophrenia or schizoaffective disorder were randomly assigned to either the community re-entry program or an equally intensive regimen of occupational therapy. The community re-entry program consisted of eight 45-minute sessions conducted with groups of six to eight patients on a continuous, twice-a-day, four-day-a-week schedule. The effects were measured by a review of the records of aftercare services that patients received in the month after discharge from the inpatient facility. Patients' knowledge and performance of the specific material taught in the community reentry program was ascertained through assessments conducted before and after training. RESULTS: Results indicated that patients in the community re-entry program significantly improved their knowledge and performance of the skills taught in the sessions, compared with patients in the occupational therapy group. Community re-entry participants were also significantly more likely to attend their first aftercare appointment than were occupational therapy participants (85 percent versus 37 percent). CONCLUSIONS: Not only can patients learn relatively complex material during a brief typical inpatient stay despite the acuteness of their illnesses, but they can also meaningfully improve the continuity of their own care by participating in a brief and highly structured training program. The program fits well within the time and staffing constraints of typical inpatient facilities.

Activities of Daily Living↗
PubMed1998

Linking inpatients with schizophrenia to outpatient care.

OBJECTIVE: This study focused on inpatients with schizophrenia or schizoaffective disorder who were scheduled to begin outpatient care with clinicians who had not previously treated them. The authors evaluated the effects of communication between the patients and their outpatient clinicians before discharge on patients' referral compliance, psychiatric symptoms, and community function at follow-up three months after discharge. METHODS: A total of 104 adult inpatients with schizophrenia or schizoaffective disorder who were scheduled to receive outpatient care from clinicians who had not previously treated them were evaluated at hospital discharge and again three months later. Comparisons were made between patients who had telephone or face-to-face contact with an outpatient clinician before hospital discharge and patients who did not have such contact. RESULTS: About half (51 percent) of the inpatient sample communicated with an outpatient clinician before leaving the hospital. Compared with patients who had no communication, those who spoke with an outpatient clinician were significantly more likely to complete the outpatient referral. After baseline scores and other covariates were controlled for, predischarge contact with an outpatient clinician was associated with a significantly lower total Brief Psychiatric Rating Scale score at follow-up and less self-assessed difficulty controlling symptoms. Nonsignificant trends toward improved medication compliance and a lower rate of homelessness were also found. The two patients groups did not significantly differ in the proportion who were readmitted to the hospital or who made a psychiatric emergency room visit during the follow-up period. CONCLUSIONS: Direct communication between inpatients and new outpatient clinicians may help smooth the transition to outpatient care and thereby contribute to improved control of clinical symptoms.

Adult↗
PubMed1992

'Not waving but drowning': psychiatric inpatient services in East Lambeth 1990.

This paper presents the results of the latest in a series of surveys of an inner-city public psychiatric inpatient service. Severe pressures on the service had led to the purchase of inpatient beds in the private hospital sector and intensive care facilities in a large psychiatric hospital. On a census day the nominal occupancy for the inpatient unit was 117%. Implications of the survey, trends over time and possible solutions to the difficulties of the inpatient unit are discussed.

Adolescent↗
PubMedDate not supplied

Sterility testing of home and inpatient parenteral nutrition solutions.

The microbial contamination rate was compared for parenteral nutrition solutions prepared by patients for home use and by pharmacy personnel for inpatient use. Phase I validated the Ivex 0.22-micron inline filter as a tool for microbiological testing by inoculating small numbers of organisms in 5% dextrose injection and testing for recovery. Phase II validated the same method for determining microbial contamination of total parenteral nutrition (TPN) solutions. Phase III compared inpatient and home TPN microbial contamination rates using the methodology validated in phase II. Test organism inocula used in phase I and II were Candida albicans, Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Proteus vulgaris, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pyogenes. All contaminated solutions in phase I showed visual turbidity within 48 hr, and all test organisms were recovered and identified. All phase II-contaminated TPN solutions showed visual turbidity after 96 hr, and all test organisms were recovered and identified. One hundred postinfusion TPN samples were collected randomly during phase III from inpatient parenteral nutrition patients. Six patients and two hospitals participated in the study. None of the 44 home parenteral nutrition samples and none of the 56 inpatient TPN samples developed visible turbidity. Subcultures of each sample on blood agar were negative for microbial growth. This described methodology offers an effective means to establish contamination rates of parenteral nutrition solutions after administration.

Adolescent↗
PubMed2000

The predictive value of dysgraphia and constructional apraxia for delirium in psychiatric inpatients.

OBJECTIVE: To evaluate the predictive value of dysgraphia and constructional apraxia for delirium among psychiatric inpatients. METHOD: Data were collected from 2 sources. First, a series of nondelirious psychiatric inpatients that had participated in a previous study was selected to determine the specificity of various indices of dysgraphia and constructional apraxia. Second, a series of 56 psychiatric inpatients with delirium as identified using electronic administrative data and clinical records was selected to evaluate sensitivity. RESULTS: Of the various indices of dysgraphia examined, only a global rating of writing quality and evidence of jagged or angled letter loops were informative clinical signs. The predictive value of constructional apraxia resembled the predictive value of the 2 dysgraphia indices. CONCLUSIONS: Dysgraphia and constructional apraxia are useful clinical signs of delirium in the psychiatric inpatient population. Evaluation of these functions can substantially impact diagnostic decisions where diagnostic uncertainty exists. An evaluation of writing and constructional praxis can be easily incorporated into bedside mental status examinations.

Adult↗
PubMed2001

Consumer satisfaction with an adolescent inpatient psychiatric unit.

OBJECTIVE: To explore factors influencing the satisfaction of patients, parents, and referring clinicians who used the services of an adolescent inpatient psychiatric unit, and to explore how levels of satisfaction related to the patient's symptomatic and functional improvement during the admission. METHOD: All 105 adolescents, their families, and the referring community clinicians who used an inpatient service over a 1-year period were asked to rate the patient's symptoms and functioning on admission, at discharge, and 4 months after the patient's return to the community. We obtained satisfaction ratings at discharge, and consumers were asked to rate helpfulness of the ward experience at 4 months postdischarge. Ward psychiatrists provided Children's Global Assessment Scale (CGAS) ratings and diagnoses over the course of the inpatient stay. RESULTS: Most of the patients (83%) improved during their admission. Consumer satisfaction ratings correlated with improvement of self-identified problems and with the perceived usefulness of discharge recommendations. Satisfaction did not, however, correlate with the patient's symptomatic and functional progress. Interaction with ward staff was an important source of both positive and negative experiences. CONCLUSION: Our study indicates that inpatient psychiatric staff should attend closely to the consumer's perception of difficulties and the need for practical discharge recommendations.

Adolescent↗
PubMed2002

Canadian psychiatric inpatient religious commitment: an association with mental health.

BACKGROUND: Research indicates that religion may have a positive effect on coping and possibly enhance clinical outcomes. This study aims to determine the level of religious interest of psychiatric inpatients and to assess whether religious commitment has an impact on selected outcome variables. METHODS: There were 88 consecutive adult patients (50% men) who were admitted to a Canadian tertiary care psychiatry inpatient unit and were interviewed about their religious beliefs and practices. Patients with a Beck Depression score of 12 or more were included for outcome analysis. RESULTS: A total of 59% believed in a God who rewards and punishes, 27% had a high frequency of worship attendance, and 35% prayed once or more daily. More frequent worship attenders had less severe depressive symptoms, shorter current length of stay, higher satisfaction with life, and lower rates of current and lifetime alcohol abuse (P < 0.05), when compared with those with less frequent or no worship attendance. In contrast, private spirituality was associated with lower depressive symptoms and current alcohol use only (P < 0.05), and prayer frequency had no significant associations. DISCUSSION: This study indicates that certain religious practices may protect against severity of symptoms, hospital use, and enhance life satisfaction among psychiatric inpatients. This is the first known Canadian study that examines religious commitment among psychiatric inpatients.

Adaptation, Psychological↗
PubMed1991

Pattern of substance abuse in psychiatric inpatients.

This study examined the pattern of substance abuse in a sample of 114 psychiatric inpatients using a standardized diagnostic interview. As predicted, psychiatric inpatients reported a significantly higher rate of substance abuse than a randomly selected community sample. Approximately three-quarters of the inpatients abused at least one substance. Almost one-half of the patient sample reported abusing more than one substance. These findings emphasize the need to screen psychiatric inpatients for substance abuse using a standardized diagnostic instrument and to develop treatment programs for substance abuse in psychiatric patients.

Adolescent↗