Managing complex patients on a medical psychiatric unit: An observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention

Hyperarousal in the hospital and what to do about it

“…Thus, we engineered a care application that improves the affordability of hospital care via mechanisms, which enhanced outpatients' flow through the medical hospital without proportionately adding staff. Compared with primary care based collaborative care interventions, an amount of 1000, €/$ cost savings was realized already one year after transition of care 20,21 . This cost reduction was due to hospital related cost savings alone and did not include further costs of social relevance (e.g., illness related sick leaf, primary care consumption etc.).…”

“…In rural areas of the US, for example, MPUs no longer have a significant impact on psychosomatic care. This observation makes sense; collaborative approaches are feasible in primary care for comorbid patients, even over long distances, with regard to the carers' communication 19,20 . Another reason why collaborative care (CC) deserved priority in the US has to do with the political circumstances behind the introduction of health care insurance for everyone.…”

“…as co ordinated case management, which is delivered by a medically supervised nurse in co operation with the patients' general practitioner and a navigating psychiatrist, improves affective and chronic disease states in multiple conditions 19,20,31 . Moving case managers (CMs) into the frontline of treatment rather than offering mental health consultation to GPs alone or providing care as usual may lead to advantages with regard to combined somatic and mental health care trajectories.…”

“…The explained variance for the final regression model in 1507 patients is 0.074. . In a cohort of patients with chronic obstructive pulmonary disease (COPD) hospitalized for an acute exacerbation, the prevalence of an abnormal HADS depression score was 44% at admittance, and 11% had an abnormal HADS anxiety score 20 . Moreover, the prevalence of affective disorders in patients with overactive bladder is considerable 7 .…”

“…In patients admitted to an internal medicine ward, self reported depressive symptoms are associated with physician's assessment of the severity of somatic conditions 19 . However, almost two thirds of all patients with abnormal scores were not identified by the attending physician as suffering from psychiatric problems 19,20 . Similarly, physicians detect only one third of all cases in somatoform disorders 21 .…”