In-patient treatment in functional and sectorised care: patient satisfaction and length of stay

Bird, Victoria; Giacco, Domenico; Nicaise, Pablo; Pfennig, Andrea; Lasalvia, Antonio; Welbel, Marta; Priebe, Stefan

doi:10.1192/bjp.2017.20

Cited by 18 publications

(25 citation statements)

References 27 publications

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“…For example, in the larger study from which this sample was drawn, it was demonstrated that patients had higher levels of satisfaction if admitted to a hospital utilising sectorised care, whereby patients see the same psychiatrist across inpatient and outpatient settings, compared to functional care, where patients see different psychiatrists across settings [35]. Again this highlights the role that staff-patient relationships may play in satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Exploring the initial experience of hospitalisation to an acute psychiatric ward

et al. 2018

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BackgroundPatient-reported satisfaction with inpatient psychiatric services, within the first few days of admission, is related to positive future outcomes. Despite its predictive value, little is known about this initial experience and what underlies these appraisals. The aim of this study was to qualitatively explore the initial experience of being admitted to an inpatient psychiatric ward.MethodsSemi-structured interviews were conducted with 61 recently admitted patients across five psychiatric hospitals in London, England. Participants were purposively sampled to ensure a mix of experiences including people with high and low satisfaction scores as measured by the Client Assessment of Treatment. Thematic analysis was used to identify, analyse and report patterns within the data, with content analysis applied to determine whether certain themes were more common to either negative or positive appraisals.ResultsFour broad themes were evident 1) ‘Best place for me right now?’ 2) ‘Different from out in society’ 3) ‘Moving from uncertainty to being informed’ and 4) ‘Relating & Alienating’. Individuals with very positive appraisals spoke most frequently of helpful relationships with both staff and other patients, and feeling cared for. They also spoke of having had previous admissions and the assessment process on entering the ward suggesting that these may be valuable experiences. Conversely, the group with very negative appraisals spoke of relationships that were alienating or where there was a perceived abuse of power. They described restrictions to their freedom, compared hospital to prison and generally had the view that hospital makes you worse.ConclusionsThe experience of hospital within the first few days of admission determines whether an individual has a positive or negative experience of their inpatient care. Reducing the impact of uncertainty and promoting good relationships may help services to improve the initial experience of hospital admission and ultimately improve future outcomes for patients.

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Section: Discussionmentioning

confidence: 99%

Exploring the initial experience of hospitalisation to an acute psychiatric ward

et al. 2018

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“…Regarding gender, a recent study hypothesized that shorter length of stay among male patients could be related to their more frequent substance abuse, which could favor to early discharge due to the difficulty in long therapeutic engagement. 19 Other studies focused on the differences between types of care organization: Bird et al, 20 in a large sample of 2709 patients admitted to 80 adult psychiatry wards, did not find any difference in term of stay length when comparing critical organizational factors: patients in care treated by the same psychiatrist across both inpatient and outpatient settings stayed on average 7 fewer days than those treated by different psychiatrists, "suggesting factors aside from the organization of care and patient characteristics have an impact on length of stay". 20 In Japan, where the length of hospitalizations often exceeds a period of one year, 6 investigated the interaction between hospital organization variables and patients' demographic and clinical features.…”

Section: Introductionmentioning

confidence: 99%

<p>Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward</p>

Lorenzo

Montardi

Panza

et al. 2020

RMHP

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To evaluate the longest hospitalizations in an acute psychiatric ward [Service of Psychiatric Diagnosis and Treatment (SPDT)] and the related demographic, clinical and organizational variables to understand the factors that contribute to long-stay (LOS) phenomenon. The term "long stay" indicates clinical, social and organizational problems responsible for delayed discharges. In psychiatry, clinical severity, social dysfunction and/ or health-care system organization appear relevant factors in prolonging stays. Patients and Methods: We divided all the SPDT hospitalizations from 1 January 2010 to 31 December 2015 into two groups based on the 97.5 th percentile of duration: ≤36 day (n=3254) and >36 day (n=81) stays, in order to compare the two groups for the selected variables. Comparisons were made using Pearson's chi-square for categorical data and t-test for continuous variables, the correlation between the LOS, as a dependent variable, and the selected variables was analyzed in stepwise multiple linear regression and in multiple logistic regression models. Results: The longest hospitalizations were significantly related to the diagnosis of "schizophrenia and other psychosis" (Pearson Chi 2 =17.24; p=0.045), the presence of moderate and severe aggressiveness (Pearson chi 2 =29; p=0.000), compulsory treatment (Pearson Chi 2 =8.05; p=0.005), parenteral or other route administration of psycho-pharmacotherapy (Pearson Chi 2 =12.91; p=0.007), poli-therapy (Pearson Chi 2 =6.40; p=0.041), complex psychiatric activities (Pearson Chi 2 =12.26; p=0.002) and rehabilitative programs (Pearson Chi 2 =37.05; p=0.000) during the hospitalization and at discharge (Pearson Chi 2 =29.89; p=0.000). Many demographic and clinical variables were statistically significantly correlated to the LOS at our multiple linear and logistic regression model. Conclusion: In our sample, clinical illness severity and need for complex therapeutic and rehabilitative treatments were associated with prolonged psychiatric hospitalizations. Understanding this phenomenon can have not only economic but also clinical, ethical and social relevance.

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“…Lindgren et al [ 50 ] found that continuity across treatment settings was associated with better long-term outcomes. Despite lack of solid evidence of whether specialization or continuity of care is more effective (length of stay) [ 48 ], studies show that patients and clinicians prefer continuity across inpatient and outpatient settings [ 48 , 49 , 51 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

How clinicians make decisions about CTOs in ACT: a qualitative study

Stuen

Landheim

Rugkåsa

et al. 2018

Int J Ment Health Syst

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BackgroundThe first 12 Norwegian assertive community treatment (ACT) teams were piloted from 2009 to 2011. Of the 338 patients included during the teams’ first year of operation, 38% were subject to community treatment orders (CTOs). In Norway as in many other Western countries, the use of CTOs is relatively high despite lack of robust evidence for their effectiveness. The purpose of the present study was to explore how responsible clinicians reason and make decisions about the continued use of CTOs, recall to hospital and the discontinuation of CTOs within an ACT setting.MethodsSemi-structured interviews with eight responsible clinicians combined with patient case files and observations of treatment planning meetings. The data were analysed using a modified grounded theory approach.ResultsThe participants emphasized that being part of a multidisciplinary team with shared caseload responsibility that provides intensive services over long periods of time allowed for more nuanced assessments and more flexible treatment solutions on CTOs. The treatment criterion was typically used to justify the need for CTO. There was substantial variation in the responsible clinicians’ legal interpretation of dangerousness, and some clinicians applied the dangerousness criterion more than others.ConclusionsAccording to the clinicians, many patients subject to CTOs were referred from hospitals and high security facilities, and decisions regarding the continuation of CTOs typically involved multiple and interacting risk factors. While patients’ need for treatment was most often applied to justify the need for CTOs, in some cases the use of CTOs was described as a tool to contain dangerousness and prevent harm.

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In-patient treatment in functional and sectorised care: patient satisfaction and length of stay

Abstract: This is the first robust evidence that patient satisfaction with in-patient treatment is higher in sectorised care, whereas findings for LoS are less conclusive. If patient satisfaction is seen as a key criterion, sectorised care seems preferable. Declarations of interest None.

Cited by 18 publications

References 27 publications

Exploring the initial experience of hospitalisation to an acute psychiatric ward

Exploring the initial experience of hospitalisation to an acute psychiatric ward

<p>Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward</p>

How clinicians make decisions about CTOs in ACT: a qualitative study

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