Patient and contextual factors related to the decision to hospitalize patients from emergency psychiatric services.

Full Abstract

OBJECTIVE:
Mental health care reform has brought an increasing emphasis on community care, with concomitant reductions in inpatient psychiatric resources. Hospitalization remains a necessary and integral component of the mental health care system, but it is taking on a more specialized role. Examining the circumstances in which hospitalization is indicated can help clarify emergency psychiatric practices and determine whether patients' needs are being met within this changing environment. This pilot study examined the impact of selected patient and contextual characteristics on the decision to admit patients to inpatient psychiatric units and assessed the utility of the Severity of Psychiatric Illness (SPI) scale for monitoring clinical practice in emergency psychiatric services.

METHODS:
Crisis workers in two emergency psychiatric services crisis teams in Toronto, Canada, used the SPI in the assessment of 205 visitors to the services during the winter of 1998-1999. Contextual characteristics, including bed availability, service site, and the admitting physician's level of training, were recorded. Multivariate logistic regression was used to assess the relative contribution of patient and contextual variables in the admission decision.

RESULTS:
The severity of axis I symptoms and difficulties with self-care were significantly associated with the decision to admit. Site, bed availability, and the admitting physician's level of training did not appear to be associated with clinical decisions.

CONCLUSIONS:
Patients with the most need are being admitted to inpatient units despite significant systemic pressures on inpatient services. The SPI is a useful and discriminating tool for evaluating clinical practice in emergency services.

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Author information

Author/s: George, Lindsey (L); Durbin, Janet (J); Sheldon, Tess (T); Goering, Paula (P);

Affiliation: Hamilton Assertive Community Treatment Team, St. George's Healthcare, 401-370 Main Street East, Hamilton, Ontario, Canada L8N 1J6. lgeorge(-atsign-)stjosham.on.ca

Journal and publication information

Publication Type: Evaluation Studies; Journal Article

Journal: Psychiatric services (Washington, D.C.) (Psychiatr Serv), published in United States. (Language: eng)

Reference: 2002-Dec; vol 53 (issue 12) : pp 1586-91

Dates: Created 2002/12/03; Completed 2003/03/21; Revised 2004/11/17;

PMID: 12461220, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Canada
Decision Making
Emergency Services, Psychiatric - standards
Female
Hospital Bed Capacity
Hospitalization
Hospitals, Psychiatric
Humans
Logistic Models

Logistic Models
Male
Mental Disorders - diagnosis; rehabilitation
Mental Health Services - standards; utilization
Patient Admission
Pilot Projects
Professional Competence
Questionnaires
Self Care
Severity of Illness Index

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