Short-stay Admissions Research Articles

Use of specialty psychiatric settings in constructing DRGs.

Characteristics of a psychiatric setting, such as staffing intensity and scope of services, are examined to see if they contribute to explaining variation in length of stay over that explained by commonly available patient descriptors. For short-stay admissions (less than 31 days), only a small improvement in predictive ability was found. Implications for prospective payment systems are discussed.

DRGs: Myths and Money

To the Editor.— Medicare initiated the transition to diagnosis related groups (DRGs) for hospital inpatient reimbursement in 1983. If DRGs successfully control Medicare's hospital costs, other reimbursers may adopt DRG payment for all inpatients. Diagnosis related groups have generated clamorous debate, yet few physicians are familiar with the costs or prevalence rates of different DRG categories. Tables 1 and 2 present the ten most common and the ten most expensive DRGs for all nonfederal short-stay hospital admissions in 1985, based on the National Hospital Discharge Survey (NHDS) and the Maryland Health Services Cost Review Commission (HSCRC).1,2The NHDS abstracts inpatient medical records from a national sample of nonfederal short-stay hospitals and classifies each admission by the DRG code published in the Aug 31, 1984, issue of theFederal Register.3The HSCRC collects data from all nonfederal short-stay Maryland hospitals, classifies each admission by the DRG code published in

Danesbury--changing patterns in the care of the younger disabled over three decades.

The pattern of care in a subregional Younger Disabled Unit (YDU) over three decades is described. The trend is now towards planned short-stay admissions, but the need for some long-stay beds remains. A survey of one district with a total population of 287,600 found 165 patients aged 18-65 with significant disability. It is suggested that there are four main categories within the younger disabled group whose requirements range from independent living to special units run by psychiatrists. The YDU is an important focal point for information on all aspects of disability.

Premature adult mortality and short‐stay hospitalization in Western Australia attributable to the smoking of tobacco, 1979‐1983

The proportions of total deaths and premature adult mortality in 1979-1983, and of short-stay hospital admissions and bed-days in 1983, that were attributable to the smoking of tobacco were estimated in Western Australia by the use of aetiological fractions that had been derived from the published literature. Premature adult mortality was measured by the person-years of life that were lost from ages 15 to 69 years (PYLL 15-69). In men it was estimated that 25% of all deaths and 14% of PYLL 15-69 were attributable to smoking. In women the corresponding proportions were 15% of deaths and 8% of PYLL 15-69. The proportions of short-stay hospital bed-days that were attributable to smoking were estimated at 7% in men and 3% in women; for hospital admissions the estimates were 4% and 1% in men and women, respectively. In all, tobacco-related disease and injury accounted for around 1700 deaths and 7500 short-stay hospitalizations each year in a population of 1.4 million persons.

Teaching psychology to psychiatric nurses: revision and implications

Changes and developments aimed at improving the effectiveness of psychology teaching to student psychiatric nurses are outlined. Many of the suggestions made in the current nursing syllabus were implemented. Pre-modular and post-modular teaching blocks have been established. The seminars given are described, covering: Short-stay admissions ward; Occupational therapy; Medium/long-stay ward; Psychogeriatrics; Community and general nursing. Practical skills teaching is emphasised via experimental workshops, and a balance maintained between theoretical and practical psychology teaching. Mid-placement review allows for feedback from the students, concerning the adequacy of the pre-modular teaching and also the placements in terms of being able to put the teaching and skills rehearsed into practice.

Short-stay Study—Utilization Review

During a 6-month period approximately 20% of the 589 patients admitted to the Maryland Institute for Emergency Medical Services Systems (MIEMSS), and who did not die, stayed less than 48 hours. About two thirds of these short-stay admissions (13% of the total number of admissions during the study period) were judged inappropriate on clinical grounds. This percentage is lower than the inappropriate rate (20%) experienced at areawide trauma centers in Maryland and may approximate the lower limit of the rate of inappropriate admissions due to unavoidable errors in triage. The inappropriately admitted patients did not impose a large fiscal or service drain on MIEMSS and did not interfere with the care of patients with more serious problems.