Inpatient Stay Research Articles

Failed Same-Calendar-Day Discharges: Understanding the Reasons for an Inpatient Stay Following Intended Outpatient Total Joint Arthroplasty

BackgroundThe adoption of Same-Calendar-Day discharge, or outpatient, arthroplasty has driven the evolution of care pathway protocols to optimize success rates of discharging patients home on the day of surgery. There are, however, instances where patients are unable to discharge on the same day as intended and require a stay in the hospital. This can lead to a poorer patient and provider care experience as well as incur additional costs. This study, therefore, aimed to determine the incidence of “failed” Same-Calendar-Day discharge, report the demographics of this patient population, and identify common reasons for failure of Same-Calendar-Day discharge. MethodsA retrospective review of a prospectively maintained regional database of 1,002 Same-Calendar-Day discharge hip and knee arthroplasty patients was performed. Patients not discharged on the Same-Calendar-Day were converted to an Enhanced Recovery After Surgery (ERAS) pathway. The ERAS conversion cohort (n = 59) was identified, and demographics, comorbidities, and reasons for conversion were reported. ResultsOf 1,002 patients in the database, 59 (5.9%) did not achieve Same-Calendar-Day discharge. The most common comorbidities were hypertension (52.5%), arthritis of the spine (22.0%), and depression and anxiety (18.6%). The median length of stay for these patients was 1 night. The all-cause 90-day readmission rate of this patient group was 5.1%. Difficulty mobilizing (n = 16), nausea and vomiting (n = 14), and social circumstances (n = 11) were the primary causes of patients being converted to ERAS pathways. ConclusionsSame-Calendar-Day discharge arthroplasty can be successfully achieved in the majority of the patient group, provided patients are assessed and treated under standard protocols that are adapted to the individual needs. Common hurdles encountered in Same-Calendar-Day discharge arthroplasty are mobilization, nausea and vomiting, and social circumstances.

Patients' Experience of Using Virtual Consultations in Their Care During Their Inpatient Stay on Acute Mental Health Admission

Patients' Experience of Using Virtual Consultations in Their Care During Their Inpatient Stay on Acute Mental Health Admission

Suspected Cauda Equina Syndrome: Can the Presence of an Orthopaedic Doctor in the Emergency Department Reduce Waiting Times for MRI Scans and Inpatient Stays?

Introduction Cauda equina syndrome (CES) is a very rare but devastating surgical emergency that can lead to permanent bowel, bladder or sexual dysfunction and lower limb paralysis. Although it is a clinical syndrome, an MRI scan is a critical diagnostic investigation for these patients and should be done as soon as possible. Our hospital is a district general hospital with no spinal services on site. There is a protocol in place for the management of these patients locally with MRI scanning during daytime hours. However, if the patient presents after 8 pm, they are discussed with the tertiary spinal centre, which then advises if the patient requires transfer overnight for urgent scanning.Considering an MRI scan is a critical diagnostic step for these patients,we introduced a role for an orthopaedic doctor in the Emergency Department (ED) to assess all of these patientsbefore collecting data for the second cycle. The aim of this audit was to see the effect of having an orthopaedic doctor in the ED for the assessment of these patients and its impact on waiting times and admission rates. Methods A closed-loop audit cycle was done looking into all referrals to trauma and orthopaedics with acute back pain and suspected CES in a district general hospital with no spinal services on site. The first cycle was between September 30, 2020, and May 31, 2021, and included 93 patients in total. Following this, a role for an orthopaedic doctor in ED was introduced from December 1, 2021, to January 31, 2022, for assessment of these patients. Data was then collected retrospectively for all patients referred during this period (n=36). Data was extracted from all relevant clinical systems including electronic patient record (EPR), Patient Pass (Patient Pass Ltd, Greater Manchester, England), which is the system used to digitally communicate with regional spinal services, and PACS (picture archiving and communication systems). The data was collated on a Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, Washinton, United States) and analysed. Results Data were collected for a total of 36 patients in the second cycle following the introduction of an orthopaedic doctor in the ED. The age of patients referred was 30-89 yearswith a mean age of 51; 44.4% were male (n=16) and 55.5% female (n=20). All the patients who were referred received their MRI scan and report within 24 hours of presentation to the ED. In the first cycle of the audit, the mean waiting time for an MRI scan had been 12.5 hours, which was reduced to eight hours following the introduction of an orthopaedic doctor in the ED during daytime hours. This was stratified further according to the time patients presented to the hospital. From 8 am to 4 pm, the mean waiting time for an MRI scan was 9.5 hours pre-intervention and 5.5 hours after. From 4 pm to 12 am, the mean waiting timewas 18 hours before and 13 hours after, and from 12 am to 8 am, the waiting time for scans improved from 8.5 hours to 6.5 hours. The number of patients discharged on the same day greatly improved from 29% (n=27) in the initial study to 58% (n=21). This decreased unnecessary inpatient stays from 71% (n=66) to 42% (n=15). Conclusion This study showed that an orthopaedic doctor in the ED for the acute assessment of patients referred with possible CES is an effective way of improving their management. This decreases waiting times for MRI scans and therefore allows the patient to be managed more efficiently.

1211 Review of the Factors Leading to an Unplanned Inpatient Stay Following a Day Case Laparoscopic Cholecystectomy in a Tertiary Centre

Abstract Aim To review the factors responsible for an unplanned Inpatient Stay (IPS) following a day case Laparoscopic Cholecystectomy (LC). To develop strategies preventing unnecessary hospital stays after Day Case LC. Method We retrospectively collected data on all the LC performed in a Tertiary Centre over 3 months (January – March 2022). Results 162 patients underwent LC during this period; 135 (83.3%) patients were planned day cases out of which 68/135 (50.37%) had an IPS and 67/135 (49.62%) were same-day discharges (SDD). 27/162 (16.66%) patients had emergency LC. 54% n = 37 LC performed in the afternoon had IPS compared to 14% n = 10 among the SDD [p<0.0001]. 47% n = 32 In-patient LC performed by non-consultant grade compared to 32% n = 22 among the SDD. 7% n = 5 IP due to social issues, 10% n = 7 no documented IP causes identified and 4% n = 3 had booking error, booked as Inpatient despite the patient having SDD. Other identified causes were drain Insertion (9% n = 6), longer operations (n = 1; mean operation time 92 min IP vs 82 min SDD) and late recovery (9% n = 6). Conclusions The rate of an unplanned overnight stay was found to be significantly high (50.37%, n = 135). Several human factors such as errors in the booking proforma, late-afternoon lists, and no clear discharge planning in the post-op notes were among the few factors which could easily be improved. A review of these factors is deemed necessary not only for improving patient outcomes & quality of care but equally for reducing healthcare costs.

Machine learning-based prediction of hospital prolonged length of stay admission at emergency department: a Gradient Boosting algorithm analysis.

This study aims to develop and compare different models to predict the Length of Stay (LoS) and the Prolonged Length of Stay (PLoS) of inpatients admitted through the emergency department (ED) in general patient settings. This aim is not only to promote any specific model but rather to suggest a decision-supporting tool (i.e., a prediction framework). We analyzed a dataset of patients admitted through the ED to the "Sant"Orsola Malpighi University Hospital of Bologna, Italy, between January 1 and October 26, 2022. PLoS was defined as any hospitalization with LoS longer than 6 days. We deployed six classification algorithms for predicting PLoS: Random Forest (RF), Support Vector Machines (SVM), Gradient Boosting (GB), AdaBoost, K-Nearest Neighbors (KNN), and logistic regression (LoR). We evaluated the performance of these models with the Brier score, the area under the ROC curve (AUC), accuracy, sensitivity (recall), specificity, precision, and F1-score. We further developed eight regression models for LoS prediction: Linear Regression (LR), including the penalized linear models Least Absolute Shrinkage and Selection Operator (LASSO), Ridge and Elastic-net regression, Support vector regression, RF regression, KNN, and eXtreme Gradient Boosting (XGBoost) regression. The model performances were measured by their mean square error, mean absolute error, and mean relative error. The dataset was randomly split into a training set (70%) and a validation set (30%). A total of 12,858 eligible patients were included in our study, of whom 60.88% had a PloS. The GB classifier best predicted PloS (accuracy 75%, AUC 75.4%, Brier score 0.181), followed by LoR classifier (accuracy 75%, AUC 75.2%, Brier score 0.182). These models also showed to be adequately calibrated. Ridge and XGBoost regressions best predicted LoS, with the smallest total prediction error. The overall prediction error is between 6 and 7 days, meaning there is a 6-7 day mean difference between actual and predicted LoS. Our results demonstrate the potential of machine learning-based methods to predict LoS and provide valuable insights into the risks behind prolonged hospitalizations. In addition to physicians' clinical expertise, the results of these models can be utilized as input to make informed decisions, such as predicting hospitalizations and enhancing the overall performance of a public healthcare system.

The Classification Algorithms Applied to the Inpatient Stay for Lower Limb Surgery.

The revolutions of recent years in health care have involved several areas ranging from patient treatment to resource management. Therefore, several strategies have been put in place to increase patient value while trying to reduce spending. Several indicators have arisen to evaluate the performance of healthcare processes. The main one is Length of Stay (LOS). In this study, classification algorithms were used to predict the LOS of patients undergoing lower extremity surgery, an increasingly common condition given the progressive aging of the population. The context is the Evangelical Hospital "Betania" in Naples (Italy) in 2019-2020, which augments a multicenter study conducted by the same research team on several hospitals in southern Italy. All selected algorithms show an Accuracy above 90% but among them, the best is Logistic Regression with a value reaching 94%.

Electrical Burn and Associated Factors That Prolong In-patient Stay in a Level Three Burn Unit.

Electrical trauma is associated with significant morbidity and mortality, which have been reduced by improved medical care, as measured by the length of stay (LOS) as a marker for this population's quality of care. This paper will review the clinical and demographic characteristics, LOS in the hospital, and variables related to patients with electrical burns. A retrospective cohort study was conducted at a specialized burn unit in Southwest Colombia. Five hundred seventy-five electrical burn-related admissions from 2000 to 2016 were reviewed for the LOS and variables including patient-related (age, gender, marital status, education, and occupation), location of the accident (domestic vs labor-related), voltage, direct contact, arc, flash, flame, clinical presentation (burn surface area, depth, single or multiple organ injury, secondary infection, and abnormal labs), and treatment (surgical procedures and intensive care unit [ICU] admission). Univariate and bivariate analysis, with its 95% CI (confidence interval). We also performed a multiple logistic regression. LOS was correlated to males, age greater than 20 years, construction workers, high voltage injuries, severe burns by area and depth, infection, ICU admission, and multiple surgical procedures or extremity amputation. LOS due to electrical injury was observed to be significantly associated with the following variables, carpal tunnel release (OR [odds ratio]= 4.25, 95% CI [confidence interval] 1.70-5.20); amputation (OR = 2.81, 95% CI 1.60-5.10); infection (OR = 2.60, 95% CI 1.30-5.20); site of infection, mainly wound (OR = 1.30, 95% CI 1.10-1.44); associated injury (OR = 1.72, 95% CI 1.00-3.24); work or domestic accident (OR = 1.83, 95% CI 1.00-3.32); aged 20-40 years (OR = 1.41, 95% CI 1.00-2.10); CPK (OR = 1.40, 95% CI 1.00-2.00); and third-degree burns (OR = 1.55, 95% CI 1.00-2.80). Risk factors for LOS secondary to electrical injury should be appropriately addressed. Prevention at high-risk workplaces is imperative. Mitigating the injury with appropriate management of infection and timely surgical interventions play an essential role in the successful treatment of these patients.

Effective Antimicrobial Stewardship in Febrile Neutropenia: A Risk Stratification Tool Combining MASCC Score and Procalcitonin Measurements Reduces Antibiotic Duration and Length of Inpatient Stay for Haemato-Oncology Patients

Effective Antimicrobial Stewardship in Febrile Neutropenia: A Risk Stratification Tool Combining MASCC Score and Procalcitonin Measurements Reduces Antibiotic Duration and Length of Inpatient Stay for Haemato-Oncology Patients

Outpatient Management of Epistaxis During COVID-19 to Reduce Inpatient Stay: A Quality Improvement Project.

Introduction In March 2020, new guidelines allowed patients with epistaxis to be discharged home with nasal packs in situ to reduce the risk of inpatient coronavirus disease 2019 (COVID-19) transmission rates. Our objective is to review how successful these new guidelines have been and whether they could be safely maintained in future practice. Methods This was a retrospective data analysis at a local tertiary ENT referral hospital. The study group consisted of patients admitted with epistaxis over one year.The "Pack and Home" criteria pathway was implemented. We reviewed this pathway six months pre- (loop 1) and six months post- (loop 2) introduction. Primary outcome measures included compliance with the "Pack and Home" criteria and length of inpatient admissions. Results A total of 131 patients required nasal packing, with 72 patients (55%) in loop 1 and 59 patients (45%) in loop 2. In loop 1, all 72 patients (100%) were admitted for inpatient care. However, in loop 2, 21 patients (36%) were discharged home with nasal packs in situ and 59 patients (64%) were admitted. Of those discharged, two patients were represented after 48 hours with rebleeding. The average total length of inpatient stay in loop 1 was significantly higher at 45.7 hours and 29.6 hours in loop 2 (p<0.05). All discharged patients attended their outpatient appointment in under three days. Conclusion The "Pack and Home" criteria can successfully identify patients who are suited for an outpatient management pathway. This could reduce surgical inpatient stay and the way we manage epistaxis.

Promoting and Maintaining Changes in Smoking Behavior for Patients Following Discharge from a Smoke-free Mental Health Inpatient Stay: Development of a Complex Intervention Using the Behavior Change Wheel.

Evidence suggests that smokers can successfully quit, remain abstinent or reduce smoking during a smoke-free mental health inpatient stay, provided behavioral/pharmacological support are offered. However, few evidence-based strategies to prevent the return to prehospital smoking behaviors post-discharge exist. We report the development of an intervention designed to support smoking-related behavior change following discharge from a smoke-free mental health stay. We followed the Behavior Change Wheel (BCW) intervention development process. The target behavior was supporting patients to change their smoking behaviors following discharge from a smoke-free mental health stay. Using systematic reviews, we identified the barriers and enablers, classified according to the Theoretical Domains Framework (TDF). Potential intervention functions to address key influences were identified by consulting the BCW and Behavior Change Technique (BCT) taxonomy. Another systematic review identified effectiveness of BCTs in this context. Stakeholder consultations were conducted to prioritize and refine intervention content. Barriers and enablers to supporting smoking cessation were identified within the domains of environmental context and resources (lack of staff time); knowledge (ill-informed interactions about smoking); social influences, and intentions (lack of intention to deliver support). Potential strategies to address these influences included goal setting, problem-solving, feedback, social support, and information on health consequences. A strategy for operationalizing these techniques into intervention components was agreed upon: Pre-discharge evaluation sessions, a personalized resource folder, tailored behavioral and text message support post-discharge, and a peer interaction group, delivered by a trained mental health worker. The intervention includes targeted resources to support smoking-related behavior change in patients following discharge from a smoke-free mental health setting. Using the BCW and TDF supported a theoretically and empirically informed process to define and develop a tailored intervention that acknowledges barriers and enablers to supporting smoking cessation in mental health settings. The result is a novel complex theory- and evidence-based intervention that will be formally tested in a randomized controlled feasibility study.

Survey on the Necessity, Sensibility, and Timing of Psycho-Oncological Counseling and the Willingness to Discuss Various Topics During the Inpatient Stay in the Case of Breast Cancer.

After the diagnosis of cancer patients require a lot of information because the disease affects all aspects of life. Some important issues regarding optimal counseling remain to be determined. This includes the time-related relevance of various topics and questions regarding who and when to consult on the topics. We analyzed the answers of 155 women with non-metastatic breast cancer undergoing primary surgery, primary chemotherapy, and having completed adjuvant treatment regarding the above-mentioned issues. We found that counseling must consider the treatment situation. Breast cancer patients in the follow-up phase reported that they preferred being counseled by female consultants. Our results largely support a counseling concept which puts the breast care nurse at the center of interest rather than psychologists and social service workers. A breast care nurse centered counseling system for women with non-metastatic breast cancer appears to meet patients' needs best.

Hospital Inpatient Stays for Autistic Youth and Youth With Other Disabilities.

Addressing health care needs is complex in autistic youth for many reasons. Increased inpatient care that has been noted in this population, particularly for ambulatory care sensitive conditions (ACSCs), may be a marker of inadequate primary and outpatient care. This study used data from hospital inpatient discharges from the National Inpatient Sample 2017. The prevalence, average length of stay, and the average cost per day of the 10 most common principal diagnoses for index stay were calculated for autistic youth and youth with mental, behavioral, and other neurodevelopmental disabilities (MBND), ages 0 to 17. Of every 1000 inpatient stays, 7.3 were for autistic youth and 65.2 for youth with MBND. The rate varied by US region and zip code-level household income. The most common diagnosis associated with stays in autistic youth was mood disorders, as in youth with MBND. Nearly all top 10 principal diagnoses for autistic youth were for ACSCs. The highest average cost per day for autistic youth was for physical injuries ($4320 per day), and the longest stays were for schizophrenia (14 days). High occurrence of ACSCs in autistic youth suggests that primary care may not adequately address health and mental health needs. Clinical complexity and autism characteristics may be impacting care received in the hospital. Additional considerations need to explore and examine care complexity, racial and ethnic disparities, and the large portion of Medicaid-covered youth. Strategies for the provision of care to these vulnerable populations are of great concern.

Postnatal Unit Experiences Associated With Exclusive Breastfeeding During the Inpatient Stay: A Cross-Sectional Online Survey.

Efforts to provide accessible and effective infant feeding support are advancing to set up new families to meeting their goals. However, data continue to be limited for understanding how inpatient postpartum support and experiences contribute to exclusive breastfeeding during hospitalization. To explore postnatal unit experiences including skin-to-skin contact, overnight support, rooming-in, responsive clinicians, and understandable communication that correlate with early infant feeding outcomes among a sample of mothers who intended to breastfeed. This was a prospective cross-sectional survey study. Through secure online survey, participants submitted (N = 2,401) responses from November 2016 to May 2017 about their experiences with maternity healthcare and offered thoughts on the postnatal unit environment. Descriptive statistics were used to examine distributions of maternal characteristics, postpartum experience, and birthing facility characteristics. Exclusive breastfeeding was positively correlated with the following postnatal unit experiences: mother did not ask that her infant be taken out of the postnatal unit room; infant staying in postnatal unit room except for treatment(s); mother got help from clinical staff when needed after pressing the call button; and nurse, midwife, and/or doctor always explained information to mother in ways that they understood. Postnatal unit experiences associated with exclusive breastfeeding during postpartum hospitalization were rooming in; parents who did not ask for their infant to be taken out of the unit room; whether mothers received timely help from clinical staff; and information was explained in a way they could understand.

931 Deep Inferior Epigastric Perforator (DIEP) Flap: Impact of Early Drain Removal on Seroma Formation Rate and Duration of Inpatient Stay

Abstract Aim Donor site seroma can follow deep inferior epigastric flap (DIEP) harvest. Post-surgery gradient technology (GTC) garments are worn by DIEP patients postoperatively following drain removal to reduce seroma formation. Early drain removal was considered a contributing factor to increased seroma formation rate. From June 2018 drain removal regardless of output was instigated at day two post-surgery. Prior to this, drains were removed when less than 30mls over 24 hours. We aim to assess the seroma rate post DIEP harvest with early drain removal. Method Retrospective review of prospectively managed database between June 2018 to May 2020. Surgical complications and length of stay in hospital were recorded. Results 200 patients underwent DIEP flap breast reconstruction. The mean age of patients was 52 years (range 28-73). There was no significant difference in seroma complication rate between those who had drains removed on day 3 compared with day 2 ((1.02% (1/98) vs. (0.98% (1/102); p = 1). The mean length of stay in hospital for the 1st cohort was 3.86 days and for the 2nd cohort was 3.23 days. There were no complications related to drain removal. Conclusions Our data suggests that drain removal after 2 days postoperatively with DIEP reconstruction does not affect seroma complication rates. Moreover, it leads to a shorter hospital stay. These conclusions are in keeping with enhanced recovery protocols and an early drain removal surgical process could be advised.

Impact of Preoperative Risk Factors on Inpatient Stay and Facility Discharge After Free Flap Reconstruction.

To determine the preoperative risk factors most predictive of prolonged length of stay (LOS) or admission to a skilled nursing facility (SNF) or inpatient rehabilitation center (IPR) after free flap reconstruction of the head and neck. Retrospective cohort study. Tertiary academic medical center. Retrospective review of 1008 patients who underwent tumor resection and free flap reconstruction of the head and neck at a tertiary referral center from 2002 to 2019. Of 1008 patients (65.7% male; mean age of 61.4 years, SD 14.0 years), 161 (15.6%) were discharged to SNF/IPR, and the median LOS was 7 days. In multiple linear regression analysis, Charlson Comorbidity Index (CCI; P < .001), American Society of Anesthesiologists (ASA) classification (P = .021), female gender (P = .023), and inability to tolerate oral diet preoperatively (P = .006) were statistically significantly related to increased LOS, whereas age, body mass index (BMI), modified frailty index (MFI), a history of prior radiation or chemotherapy, and home oxygen use were not. Multiple logistic regression analysis demonstrated that CCI (odds ratio [OR] = 1.119, confidence interval [CI] 1.023-1.223), age (OR = 1.082, CI 1.056-1.108), and BMI <19.0 (OR = 2.141, CI 1.159-3.807) were the only variables statistically significantly related to posthospital placement in an SNF or IPR. Common tools for assessing frailty and need for additional care may be inadequate in a head and neck reconstructive population. CCI appears to be the best of the aggregate metrics assessed, with significant relationships to both LOS and placement in SNF/IPR.

723-P: Efficacy and Safety of Once-Daily Fixed-Ratio Coformulation of Degludec-Aspart plus Empa-Lina 25/5 FDC in Post-Discharge COVID-19 Pneumonitis T2DM Patients Treated with Dexamethasone during Inpatient Stay

Background: Poor compliance is reported in hospitalised patients with T2D and COVID-19 who are discharged on Basal Bolus therapy (BBT). Hence, it is mandatory to explore novel therapeutic approaches. Methods: A single-centred retrospective study aimed to evaluate the safety and efficacy of once daily IDegAsp plus Empagliflozin-Linagliptin FDC ± Metformin in T2DM patients who were non-compliant to BBT after being discharged from hospital post dexamethasone therapy. Results: A retrospective chart analysis performed between 01 June 2020 and 31st December 2020 yielded a record of 67 patients (33 Female and 34 Male) meeting the eligibility criterion. Mean age of patients is 59.63 ± 9.89 years. Of the 67 patients, 59 (88.05%) were non-compliant with 3 bolus doses, 43 (64.18%) with 2 bolus doses and 21 (31.34%) with one bolus dose. The compliance was highest with once daily basal insulin in 64 (94.02%) of patients. It was further observed that the basal dose was sub-optimally up titrated to achieve fasting plasma glucose target and hence 100% failed to achieve their glycemic goals 14 days post discharge. The patients non-compliant with BBT regime and failing to achieve glycemic target post discharge, were switched to once daily IDegAsp along with Empa-Lina 25/5 FDC ± 1 gram of metformin. At the end of 13 weeks, the HbA1c reduced from 10.67±2.1% to 6.85±0.54% (p&amp;lt;0.001) with FPG and PPG both declining from 212.72±52.01 to 118.68±15.54 mg/dL (p&amp;lt;0.001) and 318.22±108.47 to 154.72±27.05 mg/dL (p&amp;lt;0.001) respectively. The initial co-formulation dose requirement was 37.81±7.42 units which subsequently reduced to 17 ± 7.29 units, (p&amp;lt;0.001). Conclusion: Switching to once daily IDegAsp and Empa-Lina 25/5 FDC ± Metformin was an efficacious and safe alternative to Basal Bolus regimen post discharge for COVID-19 pneumonitis in T2DM patients treated with Dexamethasone during in-patient stay. Disclosure S. Bhattacharyya: None.

Sociodemographic and Clinical Predictors of the Length of Psychiatric Inpatient Stay of Immigrants in Switzerland.

Immigrants with mental disorders have consistently been reported to spend shorter time in the psychiatric hospital compared to native patients. The aim of this study was to identify sociodemographic, clinical and migration-related predictors of a shorter length of psychiatric inpatient stay among immigrants in Switzerland. All patients of a foreign nationality admitted for inpatient treatment in the year 2016 (N = 279) were included in this study. The sample characteristics were drawn from the register of the psychiatric hospital. Within this sample, self-harm and substance use predicted a shorter inpatient treatment episode whereas disturbances of general psychosocial functioning were a predictor of a longer length of stay. As similar results were also reported for non-immigrant patients, the impact of these specific behavioral and social problems on the length of inpatient stay does not appear to be migrant-specific. Moreover, a country of origin outside Europe was a strong predictor of shorter length of stay pointing to inequalities of inpatient psychiatric treatment within the group of immigrants. Therefore, the cultural background and migrant history of immigrants in psychiatry need stronger consideration in order to eliminate disadvantages in mental health care.

Investigating Changes in Patients' Smoking Behavior, Tobacco Dependence, and Motivation to Stop Smoking Following a "Smoke-Free" Mental Health Inpatient Stay: Results From a Longitudinal Survey in England.

In line with national guidance, mental health Trusts in England are implementing complete smoke-free policies. We investigated inpatients' changes in smoking behavior, tobacco dependence, vaping, and motivation to stop smoking between pre-admission and post-discharge. We surveyed acute adult mental health inpatients from 14 wards in three mental health Trusts in England in 2019. Structured face-to-face and telephone interviews with patients who smoked on or during admission were conducted during the admission period and at one week and one month after discharge. Data on smoking status; daily cigarette consumption; Heaviness of Smoking Index (HSI); Strength of Urges to Smoke (SUTS); Motivation to Stop Smoking (MTSS) and vaping were collected and analyzed using regression and probit models. Inpatient smoking prevalence was 51.9%, and a total of 152 of all 555 eligible smokers (27%) were recruited. Attrition was high: 49.3% at the first and 50.7% at the second follow-up interview. Changes in self-reported smoking status, motivation to quit, and vaping did not change significantly over the study period. Cigarette consumption (p < 0.001) and Heaviness of Smoking Index (p < 0.001) modestly reduced. The frequency and strength of urges to smoke (p = 0.011 and 0.012, respectively) decreased modestly after discharge but were scored as high by 57% and 60% of participants during admission respectively. Just over half (56%) reported being offered smoking cessation support on admission. This study identified very modest changes in smoking-related outcomes during and after admission and indicates major challenges to smoke-free policy implementation, including limited support for patients who smoke. Despite mental health Trusts in England had developed and implemented smoke-free policies to meet national guidelines, adherence to these policies and provision of effective smoking cessation and temporary abstinence support for inpatients admitted to acute adult mental health wards appear to be limited. Patients who smoke on admission are likely to continue to do so during admission and after discharge, and only a very modest change in smoking behaviors appears to take place. Important opportunities to promote smoking cessation in this population are missed. Barriers to effective support need to be identified and addressed.

Involuntary Commitments: Billing Patients for Forced Psychiatric Care

Involuntary Commitments: Billing Patients for Forced Psychiatric Care

Health Disparities, Inpatient Stays, and Emergency Room Visits Among Lesbian, Gay, and Bisexual People: Evidence From a Mental Health System

This study examined differences in health outcomes and acute service use between lesbian, gay, and bisexual (LGB) individuals and a matched heterosexual control group. Individuals ages 18 to 85 whose electronic health records indicated a sexual orientation as LGB and who were included in the 2015 New York State Office of Mental Health Patient Characteristics Survey (N=5,775) were matched with heterosexuals (N=5,775) by sex assigned at birth, age, race, Hispanic ethnicity, and county of residence and compared on health status indicators, conditions and behaviors, and acute service use. Generalized estimating equation models were used to estimate the odds and rates of acute service use. LGB individuals appeared to have more chronic general medical conditions and physical disabilities and tended to use fewer acute services compared with heterosexuals. Gay men and lesbians were significantly less likely than heterosexuals to have used a mental health-related inpatient service (adjusted odds ratio [AOR]=0.69, 95% confidence interval [CI]=0.57-0.85; and AOR=0.73, 95% CI=0.59-0.89 [respectively]) or emergency room (ER) service in the past 12 months (AOR=0.63, 95% CI=0.53-0.76; and AOR=0.79, 95% CI=0.66-0.94 [respectively]). Bisexual men and women were more likely than heterosexuals to have shorter substance use-related inpatient stays (rate ratio [RR]=0.65, 95% CI=0.47-0.90; and RR=0.66, 95% CI=0.51-0.86 [respectively]) and to have fewer substance use-related ER visits (RR=0.69, 95% CI=0.48-0.99; and RR=0.55, 95% CI=0.43-0.69 [respectively]). The health care system needs strategies in LGB-centered care, research, medical education, health policy, and evidence-based practices to engage sexual minority groups in mental health and general medical care.