Hampshire Hospital Research Articles

A hospital capacity planning model

Current health reforms mean that the Royal Hampshire Hospital, like many others, needs to examine its use of resources very carefully In particular, it has to understand how various casemix combinations impact on the way resources are used and attempt to define feasible packages of care. Previously, the hospital was funded on a fixed budget and was forced to constrain its costs within this even if that meant slowing down or stopping elective work. The new arrangements require the hospital to bid competitively for agreed volumes of workload. Two of the many issues raised by the new system are the need for an accurate knowledge of the day to day capacity of the hospital and the behaviour of the hospital system under different case-mixtures. The model described in this article attempts to address this problem of capacity.

Effects of a limiting Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia.

We examined the effects of a three-prescription monthly payment limit (cap) on the use of psychotropic drugs and acute mental health care by noninstitutionalized patients with schizophrenia. We hypothesized that reducing access to such drugs would increase the use of emergency mental health services and the rate of partial hospitalizations (full-day or half-day treatment programs) and psychiatric-hospital admissions. We linked Medicaid claims data for a period of 42 months with clinical records from two community mental health centers (CMHCs) and the single state psychiatric hospital in New Hampshire, where Medicaid imposed a three-prescription limit on reimbursement for drugs during 11 months (months 15 through 25) of the study. For comparison, we used Medicaid claims for a period of 42 months in New Jersey, which had no limit on drug reimbursement. The study patients (n = 268) and the comparison patients (n = 1959) were permanently disabled, noninstitutionalized patients with schizophrenia, 19 through 60 years of age, who were insured by Medicaid. We conducted interrupted time-series regression analyses to estimate the effects of the cap on the use of medications and mental health services. The cap resulted in immediate reductions (range, 15 to 49 percent) in the use of antipsychotic drugs, antidepressants and lithium, and anxiolytic and hypnotic drugs (P < 0.01). It also resulted in coincident increases of one to two visits per patient per month in visits to CMHCs (range of increase, 43 to 57 percent; P < 0.001) and sharp increases in the use of emergency mental health services and partial hospitalization (1.2 to 1.4 episodes per patient per month), but no change in the frequency of hospital admissions. After the cap was discontinued, the use of medications and most mental health services reverted to base-line levels (measured in the first 14 months of the study). The estimated average increase in mental health care costs per patient during the cap ($1,530) exceeded the savings in drug costs to Medicaid by a factor of 17. Limits on coverage for the costs of prescription drugs can increase the use of acute mental health services among low-income patients with chronic mental illnesses and increase costs to the government, even aside from the increases caused in pain and suffering on the part of patients.

Clozapine-induced seizures and EEG changes.

Clozapine, an atypical antipsychotic drug, is widely used in refractory schizophrenia. At New Hampshire Hospital, 7 of the first 35 patients treated (20%) had convulsions. Patterns were tonic-clonic (5), complex partial (2), and myoclonic (3). Seizures were dose-related and may be anticholinergic in etiology. EEG changes are frequent with clozapine, particularly as dosage is increased. Twenty-six of 35 patients (74%) had EEG abnormalities at some time during clozapine treatment. EEG is a sensitive means of detecting clinical toxicity. When EEG abnormalities (slowing, dysrhythmia, or paroxysmal discharges) are detected, immediately lowering the dose by at least 25-50 mg per day and adjusting weekly until EEG returns to baseline can reduce the incidence of seizures.

Hospital tender to accept private bids.

NHS providers will be asked to compete with the private sector for contracts to build and run a new community hospital in Hampshire.

Redundancy threats for nursing posts in SW Hampshire.

Nurses at a Hampshire hospital face redundancy, the RCN said last week, after Southampton and SW Hampshire HA withdrew its contract.

Avoiding negligent release: contemporary clinical and risk management strategies

Mental health professionals often must decide whether to release a psychiatric patient who has been committed for treatment on the basis of being mentally ill and dangerous. This decision involves liability risks if the patient becomes violent after release. The author draws together several recommendations made in the literature regarding the careful development and implementation of hospital release procedures, including 1) special consultation at the policy development stage, 2) preemptive judgments regarding the adequacy of hospital policies in relation to the professional standard of care, and 3) the use of videotaped exit interviews with patients at the time of their release.

Using routine documentation of medical care to observe physician behavior.

This observational study compared the utilization of pulmonary function tests (PFTs) for outpatients at community hospitals in New Hampshire in 1975 and 1980. It was hypothesized that if preliminary care physicians were shifting toward using PFTs for early detection of chronic obstructive airway disease (COAD), an increase in the number of tests ordered, a decrease in the mean age of patients tested, and an increase in the mean lung functions (FEV1/FVC) would be observed. For hospitals providing data for 1975 and 1980, 85% showed an increase in the number of outpatient tests ordered (p = 0.002), the mean age of outpatients tested decreased at 75% of the hospitals (p = 0.019), and the mean FEV1/FVC increased at 67% of the hospitals (p = 0.014). The hypotheses thus confirmed, it is concluded that New Hampshire physicians are using PFTs for early detection of COAD.

Behavior modification as a therapeutic technique for use with parents of emotionally disturbed children in residential treatment.

This paper is based on the experience of the author in establishing and directing a program of behavior modification for children and their parents at the New Hampshire Hospital. The focus is on the operant conditioning procedures used with the parents to foster improved relationships with their children and between spouses. Attention was given to the promotion of awareness and praise for productive behaviors and extinction of hostility. Modeling, prompting, shaping, ignoring, and reinforcement principles were followed in parent activities such as TV viewing, individual and group counseling, and controlled visits with children.

Problems in Prediction of a Schizophrenic Population

BRILL and Patton reported an exhaustive statistical analysis of the New York mental hospitals in 1962 and predicted a decline of 15% to 20% in the schizophrenic population by 1970.¹This is consistent with the decreasing resident population trends in most mental disorders and it would be expected that the schizophrenic population would decrease with the rest of the hospital population. However, Brill and Patton's study used predictions based on trends which take into account only recent years; it is desirable to check their findings in another hospital in the perspective of a longer span of time. The present paper deals with (1) an estimate of future schizophrenic population and (2) the problems of estimation arising from changes in trends of retention of schizophrenic population at New Hampshire Hospital. The prediction project was undertaken when the hospital trustees asked for a population estimate

Surgical care of complicated gastric and duodenal ulcer in small hospitals.

THIS report is concerned with the surgical care of gastric and duodenal ulcers in two small hospitals in New Hampshire. It covers a period of two and a half years, ending June 30, 1953, during which gastric resection for gastric, duodenal or gastrojejunal ulcer was performed in 103 cases.The types of ulcer and primary indications for resection are presented in Table 1. Intractability includes failure of either a gastric or duodenal ulcer to heal on medical therapy, persistent pain or bleeding on a good medical program and repeated perforation.The circumstances of gastric resection are outlined in Table 2. The word . . .