Abstract
Objective The aim of this study is to examine the impact of opening a medical psychiatric unit (MPU) on a variety of outcomes. Methods In this non-equivalent groups design, there were two groups: ‘pre-MPU’ and ‘actual MPU’. Staff assessed whether patients in the pre-MPU group were eligible for admission to a planned MPU, resulting in virtual admissions and discharges. The actual MPU group consisted of patients admitted after opening of the MPU. Results The length of stay (LOS) in the hospital was one day longer for patients in the MPU group (8.68 vs. 9.89, p = .004), but the LOS on the MPU was comparable in both groups (5.63 vs. 6.06, p = .231). The LOS on the intensive care unit (ICU) was longer in the MPU group (0.10 vs. 0.40, p < .001), even as the time patients were physically restraint (0.28 vs. 0.83, p < .001). In the pre-MPU group, the odds were not significantly different for involuntary commitment (OR = 0.92; p = .866) and death within six months after discharge (OR = 1.84; p = .196). Conclusions Both physical restraint and ICU admission have a link with patient complexity, it therefore seemed that opening of the MPU resulted in the treatment of more complex patients with a comparable LOS on the MPU. KEY POINTS The LOS on the MPU was not significantly different between the groups before and after opening of the MPU. Opening of the MPU resulted in the admission of patients that were admitted more days to the ICU and to more days of physically restraint. It can be considered that opening of the MPU resulted in an increased ability to treat complex patients.
Highlights
From 1980 onwards, medical psychiatric units (MPUs) have opened worldwide and are designed to address the needs of complex patients with concurrent medical and psychiatric disorders
We aimed to examine the impact of opening a type III/IV unit on length of stay (LOS), intensive care unit (ICU) admission, physical restraint, involuntary commitment, and mortality
The pre-MPU group consisted of 58 patients, in 2012, a total number of 174 patients were admitted to the MPU: these patients formed the actual MPU group
Summary
Despite the existence of these units for several decades, the impact of opening an MPU on treatment effects has not been studied. In 1989, Young and Harsch compared the length of stay (LOS) on an MPU with the LOS on a regular psychiatry unit and general medicine inpatient units. They found a decrease in mean LOS from more than 20 to less than 15 days (Young and Harsch 1989). Six years later Gertler et al studied differences in LOS between an MPU and a general psychiatry unit. Despite patients on the MPU having multiple diagnoses and being considered more complex, the LOS between the units was comparable, suggesting costeffective care on the MPU (Gertler et al 1995). Kishi and Kathol found comparable outcomes in 1999 when they compared patients on an internal medicine ward with patients on a highacuity ward (Kishi and Kathol 1999)
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