Need analysis for a new high acuity medical psychiatry unit: which patients are considered for admission?

Abstract

Background The study aims were: to estimate the proportion of patients with an indication for admission to a new high acuity Medical Psychiatric Unit (MPU), to explore the reasons for MPU-admission according to different health disciplines, and to check for differences in patient characteristics. The results of this study are to be utilized in the proposed establishment of a high-acuity MPU in a University Medical Center. Such a unit currently does not exist at Erasmus MC. Methods Hospital in-patients were included if they received psychiatric consultation from the Psychiatric Consultative Service (PCS). As part of the study protocol, psychiatrists, other medical specialists, and nurses determined the need for admission to the proposed MPU. Patient groups were compared with respect to diagnoses, socio-demographic characteristics and patient routing. Results One hundred and fifty-one patients were included, 43% had an indication for MPU-admission, for the other patients PCS involvement was sufficient. There was agreement on suicide attempts as a reason for MPU-admission. For psychiatrists, the need for further diagnostic evaluation was a common reason for MPU admission, while other medical specialists more often emphasized the need for safety measures. Patients with an unplanned hospital admission had a higher chance of MPU eligibility (OR = 2.72, 95% CI 1.10–6.70). The main psychiatric diagnoses of MPU-eligible patients were organic disorders (including delirium), mood disorders, and disorders related to substance abuse. The most common diagnoses found were similar to those in previous research on MPU populations. Conclusion Different medical disciplines have different views on the advantages of MPUs, while all see the need for such facilities. The proposed MPU should be able to accommodate patients directly from the Emergency Unit, and the MPU should provide specialized diagnostic care in an extra safe environment.

Defining Vision and Mission of a Medical Psychiatry Unit (MPU) for Older Adults: A Focus Group Study

“… 42 Primary care medical specialists and psychiatrists work closely together at these units. Caarls et al 23 found that MPUs in general are the most effective in providing care for high-level psychiatric and medical patients with complex conditions in particular. Previous studies described a gap between managers and nonmanagers concerning mission statements in a hospital setting.…”

“…The reasons for setting up such a unit fall into several categories and are similar to the reasons why an MPU in Erasmus MC (Rotterdam, The Netherlands) was recently established: (1) managing the increasing complexity and behavior that is disruptive to physical treatment in an aging and more often multimorbid population, (2) improving the quality of care, and (3) the promise of cost-effectiveness by reducing length of stay and readmissions. 23 …”

The Impact of COVID-19 on Psychiatric Acuity in a Community Psychiatric Hospital

“…Type 4 relates to high psychiatric/high medical acuity units or portions of medical units that provide high acuity medical/psychiatry care. Caarls et al (2019) discussed the concept of acuity in the context of the complexity of psychiatric and medical needs without defining acuity. Howver (2014) developed the Vanderbilt acuity tool for nurses to assess acuity, establish the required care level, and appropriately utilize resources.…”

Die psychiatrische Intensivstation an einer Klinik der Supramaximalversorgung – Analyse der Behandlungsvariablen aus der Therapie Psychiatrischer und Komorbider Somatischer Erkrankungen

“…Anders in den USA [3], wo steigende Gesundheitskosten und eine Reform der medizinischen Ausbildung seit den 1930er Jahren zu einer schrittweisen Rückkehr der Psychiatrie in den "medizinischen Mainstream" führten. Heute gibt es dort etwa 1700 psychiatrische Einheiten an Allgemeinkrankenhäusern, teils in Form spezialisierter Einrichtungen für komorbid erkrankte Patienten [23]. In Deutschland ist ein Zusammenwachsen von somatischer Medizin und Psychiatrie mit der Psychiatrie Enquete der 1970er Jahre verbunden.…”