Factors affecting length of stay in a psychiatric intensive care unit

Michalon, Max; Richman, Alex

doi:10.1016/0163-8343(90)90047-g

Cited by 33 publications

(26 citation statements)

References 12 publications

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“…However, the issues raised may be relevant to all PICUs in the UK, because existing evidence from other countries highlights the importance of the PICUs relationship with other units (Michalon and Richman, 1990). …”

Section: Limitations Of the Studymentioning

confidence: 99%

Psychiatric nurses’ views on criteria for psychiatric intensive care: acute and intensive care staff compared

Bowers

Crowhurst

Alexander

et al. 2003

International Journal of Nursing Studies

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Aim: To explore and investigate differences between the views of qualified nurses working in psychiatric intensive care units (PICUs) and acute care wards on which patients are appropriate for PICU care.Background: Previous research on the area of psychiatric intensive care highlights the great differences that exist in all aspects of service provision, from unit size and staffing levels to treatment approaches and physical environment. One of the most common areas of controversy is the type of client behaviour that warrants admission to the PICU. Method: Structured interviews of 100 qualified nursing staff (in the London area, England) working on either acute or PICU wards were used to gather data on appropriate and inappropriate referral to PICUs. Comments made during the course of the interviews were also collected and subjected to content analysis.Findings: There was evidence to support the hypothesis that acute ward staff considered patients suitable for PICU care at a lower level of risk than PICU staff thought appropriate. In comparison to acute ward nurses, those working in PICUs attended to a broader range of factors when considering suitability for admission to PICU. Appropriate reasons for transfer fell into five groups: risk to others; risk of intentional harm to self; risk of unintentional harm to self; therapeutic benefit from the PICU environment; and legitimate acute ward care problem. Inappropriate reasons for transfer fell into four groups: low risk to others and/or self; illegitimate acute admission care problems; patient belongs elsewhere; policy issues. Conclusion:The study opens up a range of issues not previously studied in relation to the use of PICUs and the intricate relationship of this use with the available acute care wards and other services. These findings and their implications for the care of acute and disturbed psychiatric patients are discussed.

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Section: Limitations Of the Studymentioning

confidence: 99%

Psychiatric nurses’ views on criteria for psychiatric intensive care: acute and intensive care staff compared

Bowers

Crowhurst

Alexander

et al. 2003

International Journal of Nursing Studies

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“…Eaton & Ghannon 2000 Goldney et al 1985Goldney et al 1986 Gordon et al 1998 Hyde et al 1998Jeffery & Goldney 1982Khan, et al 1987Michalon & Richman 1990Mitchell 1992Musisi et al 1989Warneke 1986Wykes & Carroll 1993 Patients giving evidence that PICU patients are younger than general acute patients Brown & Bass 2004Cohen & Khan 1990 Gordon et al 1998 Khan et al 1987Rachlin 1973 Papers …”

Section: Papers Indicating Patients Mean Age In 30smentioning

confidence: 99%

“…A number of studies report or mention other types of containment used while patients are in PICU care: medication (coerced or rapid tranquillisation or PRN, see Table 1) ; seclusion (Brown & Bass 2004;Cohen & Khan 1990;Ford & Whiffin 1991;Hafner, Lammersma, Ferris, & Cameron 1989;Khan, Cohen, Chiles, Stowell, Hyde, & Robbins 1987;Michalon & Richman 1990;O'Brien & Cole 2004;Wynaden et al 2001); special observation (Citrome, Green, & Fost 1994;Hyde & Harrower-Wilson 1996); mechanical restraint (Cohen & Khan 1990;Khan, Cohen, Chiles, Stowell, Hyde, & Robbins 1987;Michalon & Richman 1990). The general impression conveyed is that such measures are used more frequently within a PICU environment than on general acute wards, and this impression is confirmed by the one study offering comparative information (Brown & Bass 2004), showing greater use of rapid tranquillisation and seclusion.…”

Section: The Incidence and Management Of Dangerous And Disruptive Behmentioning

confidence: 99%

“… 27% over 2.5 years (Jeffery & Goldney 1982)  29% over 3 years (Michalon & Richman 1990)  49% over 3.5 years (Goldney, Bowes, Spence, Czeckhowicz, & Hurley 1985;Goldney, Spence, & Bowes 1986)  57% over 5 years (Smith & Humphreys 1997).…”

Section: Studies Not Fitting Any Of the Above Categoriesmentioning

confidence: 99%

“…Those in the USA and Canada are less well described or studied, and seem to vary a great deal, as one might expect in countries that have multiple overlapping health care systems. For example, one studied unit placed all patients in isolation, seclusion or restraint for the first 48 hours (Cohen & Khan 1990;Khan et al 1987), whereas another took physically ill psychiatric patients alongside other disturbed patients and was not always locked (Michalon & Richman 1990). …”

Section: What Is a Picu?mentioning

confidence: 99%

See 2 more Smart Citations

Psychiatric Intensive Care Units: a Literature Review

Bowers

Jeffery

Bilgin

et al. 2008

Int J Soc Psychiatry

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Length of stay in a German psychiatric hospital as a function of patient and organizational characteristics – a multilevel analysis

Frick

Rehm

Krischker

et al. 1999

Int J Methods Psych Res

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Hierarchical linear modelling (HLM) was used to compare the influence of individual and organizational variables on patients' length of stay (LOS) in a large psychiatric hospital in Germany. Organizational variables used were characteristics of the different wards, such as capacity, staff workload, and diagnosis mix. About 28% of the variance in the final hierarchical model was explained by the wards (between‐wards variance) and about 13% by individual or ‘level‐1’ variables. Individual predictors with significant influence included age, diagnosis, level of social functioning and its improvement during therapy, medication, and discharge to complementary services or to subsequent outpatient treatment. Significant organizational variables influencing LOS were number of nursing personnel per bed day, average level of social functioning among patients of each ward, and proportion of patients with schizophrenic disorders treated in each ward.The results are compared with other studies from the recent literature on LOS. General advantages of HLM in the comparisons of hospitals or other health care organizations are illustrated. It is concluded that HLM analysis should be employed regularly in quality management and cost‐containment studies of different healthcare providers. Copyright © 1999 Whurr Publishers Ltd.

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Factors affecting length of stay in a psychiatric intensive care unit

Cited by 33 publications

References 12 publications

Psychiatric nurses’ views on criteria for psychiatric intensive care: acute and intensive care staff compared

Psychiatric nurses’ views on criteria for psychiatric intensive care: acute and intensive care staff compared

Psychiatric Intensive Care Units: a Literature Review

Length of stay in a German psychiatric hospital as a function of patient and organizational characteristics – a multilevel analysis

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