Increasing Access to State Psychiatric Hospital Beds: Exploring Supply-Side Solutions

Abstract

The objective of this study was to identify supply-side interventions to reduce state psychiatric hospital admission delays. Healthcare Enterprise Accounts Receivable Tracking System (HEARTS) data were collected for all patients admitted between July 1, 2010, and July 31, 2012, to one of North Carolina's three state-operated psychiatric hospitals (N=3,156). Additional information on hospital use was collected at nine meetings with hospital administrators and other local stakeholders. A discrete-event simulation model was built to simulate the flow of adult nonforensic patients through the hospital. Hypothetical scenarios were used to evaluate the effects of varying levels of increased capacity on annual number of admissions and average patient wait time prior to admission. In the base case, the model closely approximated actual state hospital utilization, with an average of 1,251±65 annual admissions and a preadmission wait time of 3.3±.1 days across 50 simulations. Results from simulated expansion scenarios highlighted substantial capacity shortfalls in the current system. For example, opening an additional 24-bed unit was projected to decrease average wait time by only 6%. Capacity would need to be increased by 165% (356 beds) to reduce average wait time below 24 hours. Without more robust community-based hospital and residential capacity, major increases in state psychiatric hospital inpatient capacity are necessary to ensure timely admission of people in crisis.