Length of stay of psychiatric admissions in a general hospital in Ethiopia: a retrospective study

Abstract

BackgroundIn sub-Saharan Africa, the number of psychiatric beds per population is disproportionately low. Moreover, there is a lack of data regarding the patterns of psychiatric admissions and the factors leading to long psychiatric hospitalization in this region. This study aimed to investigate the average length of stay (LOS) and the factors associated with prolonged hospitalizations.MethodsA ten-year retrospective chart review of patients admitted to the psychiatric facility of Jimma University Specialized Hospital in southwest Ethiopia was conducted. The medical charts of 846 admissions spanning the period from January 2001 to December 2010 were reviewed. LOS greater than 21 days was considered as a cut-off point for lengthier stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors independently associated with LOS.ResultsThe most common discharge diagnoses were schizophrenia and other psychotic disorders (27.6%), and bipolar disorder (23.4%). A global clinical rating taken on discharge showed 90.3% improved outcome. The median (25th, 75th percentiles) LOS was 22 (15, 36) days. Patients with major depressive disorder [aOR = 0.51 (0.32 – 0.81)] and brief psychotic disorder [aOR = 0.52 (0.33 – 0.84)] were less likely than patients with schizophrenia and other psychotic disorders to have long hospital stays. Presence of extrapyramidal side-effects and out of pocket expenditures predicted LOS.ConclusionsPatients with psychoses and bipolar disorder have lengthier hospital stays burdening the cost of care of psychiatric treatment in a general hospital setting. Our findings call for identifying those cases quickly, attending to their needs with evidence-based efficient treatment and for improving and developing an aftercare system such that the utilization of acute inpatient beds, already a scarce resource, could achieve higher efficiency.

Doctor to Patient Ratio and Infrastructure Gap in a Psychiatric Hospital in Oil Rich Eket, Nigeria

“…(n=106 vs. n=870 in this study). This was reinforced in a finding in a London study that the proportion of admissions for schizophrenia and related psychoses was higher than for depression and anxiety in London [28].…”

“…This falls into the category of critical bed shortage (<12 beds per 100,000), with many patients lying on the floor [4,44]. The pressure on beds appears to reflect a wider mismatch of provision and need [28]. This is in consonance with the fact that shortage of beds in acute psychiatric units is related to both social deprivation and the overall availability of acute beds [41,42].…”

“…The situation in the study center is even made worse by the leaking roofs, eroded doors, no window blinds or panes, and broken doors [6]. This should lead to increasing concerns about both the adequacy of current levels of provision and the quality of the care provided [28].…”

“…The implication of all these therefore, is that within each local health community, the requirement for acute mental health beds needs to be assessed in the context of the whole mental health system [28].…”

“…This may be because of better funding, management and multi sectoral and international collaboration. Conversely the number of beds in advanced countries like England is falling not because of shortage or non-availability but because of deinstitutionalization [28,30].…”