Abstract
BackgroundThe NHS Mental Health Implementation Plan aims to reduce length of inpatient psychiatric stays to a maximum of 32 days, yet provides little guidance on how to achieve this.Previous studies have attempted to analyse factors influencing length of stay in mental health units, focussing mostly on patient factors. These models fail to sufficiently explain the variation in duration of inpatient stay. We assess how the type of service delivered by a trust, in addition to patient factors, influences length of stay.MethodsWe conducted a retrospective case cohort study in a large inner-city NHS mental health trust for all admissions in a 1 month period. Data was gathered from electronic notes of 105 patients. Descriptive univariate and bivariate analyses were conducted on the data, with multiple regression analysis conducted on statistically significant data.ResultsShort-stay assessment ward admission significantly reduced length of stay. Patients under outpatients or under care co-ordination, admitted through Mental Health Act assessment and formally detained all had longer length of stay. Out of area admissions, locum Consultant care, changing Responsible Clinician and ward transfers all led to longer length of stay. Factors indicating more severe illness such as increased observation level and polypharmacy, as well as diagnoses of psychosis or bipolar disorder were associated with longer duration of stay. Discharges requiring referral to accommodation or rehabilitation led to longer stays. The most significant factors that influenced length of stay were higher observation levels, diagnosis of psychotic illness or bipolar, and discharge to rehabilitation placement.The final model, taking into account all these factors, was able to account for 59.6% of the variability in length of stay.ConclusionsThe study backs up existing literature which shows patient-factors have an influence on length of stay. The study also demonstrates that service-level factors have an impact on the duration of stay. This data may be used to inform further studies which may aid provision of inpatient and community services in the future.
Highlights
The National Health Service (NHS) Mental Health Implementation Plan aims to reduce length of inpatient psychiatric stays to a maximum of 32 days, yet provides little guidance on how to achieve this
Our study reinforces several of the findings from previous studies regarding factors that influence length of stay for acute psychiatric patients
We have demonstrated that patient factors including diagnosis, need for increased observations and multiple medications have significant impact
Summary
The NHS Mental Health Implementation Plan aims to reduce length of inpatient psychiatric stays to a maximum of 32 days, yet provides little guidance on how to achieve this. Previous studies have attempted to analyse factors influencing length of stay in mental health units, focussing mostly on patient factors. The NHS Mental Health Implementation Plan sets a target of reducing length of stay to a maximum of 32 days, putting the onus on Trusts to develop ways of achieving this [3]. As part of the NHS Long Term Plan, funding is being made available to achieve this goal, but Trusts must develop an understanding of what factors influence length of stay before implementing service change. Recent studies have looked at patient factors, demographics, diagnosis and severity in order to predict length of inpatient stay, with varying and sometimes conflicting results [5,6,7]
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