Abstract
Aims and MethodTo examine the pathways and outcomes of in-patient care in our locality before crisis teams were introduced details of all emergency referrals to psychiatry were recorded and all admissions to hospital were assessed within 24 h of admission and discharge.ResultsOver a 6-month period, 88% (n=1852) of calls to the duty psychiatrist occurred between 09.00 and 01.00 h. Referrals from accident and emergency and general practice represented the majority of calls (80%); 40% of patients were admitted. Highest admission rates were for patients who were psychotic, suicidal or depressed. Admission led to improvement in all symptoms.Clinical ImplicationsIn-patient care is a valuable resource for stabilising patients who are acutely ill. Routine monitoring of unscheduled activity can inform service delivery.
Highlights
The source and number of referrals were as follows: general practitioners, n=606 (43%); emergency department, n=546 (38%); physicians, n=301 (15%); community mental health teams (CMHTs), n=154 (73%); transfers from other hospitals, n=147 (63%); liaison psychiatry, n=57 (46%); psychiatric day hospital, n=35 (23%), non-psychiatric wards, n=28 (14%); others, n=149 (54%)
In our traditional model of care, hospital admission occurred in 40% of emergency contacts with the on-call doctor
In areas where specialist teams are developed, hospital admission is probably being reserved for patients who are more severely ill (Commander & Disanyake, 2006)
Summary
Over a 6-month period, 88% (n=1852) of calls to the duty psychiatrist occurred between 09.00 and 01.00 h. Recent years have seen the development of specialist crisis and home treatment teams for managing patients who would previously have been admitted for in-patient care (Glover et al, 2006). Studies of acute hospitalisation in psychiatry have been comparisons between forms of home treatment or day hospital care and the ‘treatment as usual’ of in-patient psychiatric care (for example, Priebe et al, 2006). To our knowledge there has been no systematic or prospective description of the use and outcomes of acute psychiatric in-patient care, despite the upheaval to the patient and cost of hospitalisation. Admission is construed as representing a failure of the individual patient or the service, rather than a potentially valuable therapeutic option.’. We aimed to examine the pathways to and therapeutic value of in-patient care in our service (NHS Lanarkshire), where crisis or home treatment teams have yet to be developed We note the recent comment by Holloway (2006) that ‘. . . admission is construed as representing a failure of the individual patient or the service, rather than a potentially valuable therapeutic option.’ We aimed to examine the pathways to and therapeutic value of in-patient care in our service (NHS Lanarkshire), where crisis or home treatment teams have yet to be developed
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