Abstract
The aim of this study was to determine if the diagnostic profile of inpatients of a psychiatric unit in a general hospital influences the length of stay. The results of a retrospective survey comprising the first 16 years of operation of the Psychiatric Unit of the Ribeirão Preto General Hospital (PURP) showed that the progressive increase observed in the length of stay correlated with the increase in percentage of schizophrenia diagnosis, after the 8th year of hospital operation, and of affective disorders, after the 12th year. The length of hospitalization kept increasing until the 16th year, even though there was no change in the diagnostic profile of the patients admitted to the unit. In a prospective study encompassing the next six months, 61 inpatients were evaluated with the Structured Clinical Interview for DSM-III-R and the Brief Psychiatric Rating Scale (BPRS). The results showed that 82% of the inpatients fulfilled the diagnostic criteria for the schizophrenic or affective disorder spectrum at admission, with a discharge rate slower than for other diagnoses, although the length of hospitalization did not significantly differ among diagnostic categories. The results further demonstrated that in every diagnostic category more than 50% of the patients stayed in hospital for more than one week after reaching a BPRS score equal to 6, indicative of discharge. Overall, these data suggest that the increase in length of hospitalization may be due to a higher percentage of patients with a diagnosis of schizophrenia and affective disorder admitted to the PURP. In addition, patients with low symptomatic levels remained in hospital longer than they should have.
Highlights
Material and MethodsMainly as a consequence of the movement for psychiatric reform, great emphasis is being currently placed on noninstitutional methods to treat psychiatric disorders, among them the setting up of psychiatric units in general hospitals (PUGHs) [1,2]
The aim of the present study was to determine whether diagnostic category and severity of psychopathology affect the length of hospitalization, by analyzing the diagnostic profile, severity of symptoms and length of stay of patients admitted to the Psychiatric Unit of the Ribeirão Preto General Hospital (PURP)
There was a significant increase in length of stay along this period of time (ANOVA: F6,54 = 8.56; P < 0.001), as well as a significant rise in the percentage of patients with diagnoses of schizophrenia (χ2 = 38.31; d.f. = 4; P < 0.001) and affective disorder (χ2 = 25.55; d.f. = 4; P < 0.001)
Summary
Material and MethodsMainly as a consequence of the movement for psychiatric reform, great emphasis is being currently placed on noninstitutional methods to treat psychiatric disorders, among them the setting up of psychiatric units in general hospitals (PUGHs) [1,2]. With the proliferation of PUGHs in the United States, there was strong pressure to reduce the length of hospitalization. In the early 80’s, the average length of time psychiatric patients stayed in general hospitals was about 18 to 20 days, and when the period was extended beyond 27 days, the hospital was not compensated for the extra days [3]. 28 days was considered as an adequate length of stay for psychiatric patients in general hospitals [4]. There has been a progressive increase in the length of hospitalization, though most investigators still believe 15 to 30 days is adequate for PUGHs [5]. 50% of hospitalizations longer than 30 days are medically justified. Another 39.7% are due to social and administrative factors beyond the psychiatrist’s control, and 10.3% are medically unacceptable
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