A study of admissions to a PICU in a Trust that has undergone significant bed closures and other service re-design

Abstract

Background: Psychiatric intensive care units (PICU) have policies based on the National Minimum Standards (NAPICU) which are adhered to with varying rigour, and this became particularly apparent following the closure of beds in a Trust. Around this time, other service changes also took place: the development of an Admission Ward and a Treatment Ward, and a change in the function of the Community Mental Health Teams.<br/> Aims: The pattern of admissions to the Trust's PICU altered, and the study aimed to confirm and characterise these changes. An association with the closure of a 20 bed general adult psychiatric ward was observed, and the study examined the pattern of admissions before and after this date, believing that the findings may inform local service planning, and be of interest to other services.<br/> Method: This naturalistic study examined the records of the 245 patients admitted in the year preceding the bed closures and the two following years. Objective information was gathered for analysis.<br/> Results: Following the bed closures there was an increase in the number of admissions, an increase in unplanned admissions not meeting the admission criteria for a PICU and an increase in patients discharged directly home. A 'lag' period was also evident before these changes became more apparent. These findings were statistically significant.<br/> Conclusions: The study found a changed pattern of admissions at the time of bed closures and other service developments. PICU admissions can be a useful barometer of the performance of a wider service.