Patient and Service-Level Factors Affecting Length of Inpatient Stay in an Acute Mental Health Service: A Retrospective Case Cohort Study

Abstract

Background: The NHS Mental Health Implementation Plan aims to reduce length of inpatient psychiatric stays to a maximum of 32 days, yet provides little guidance on how to achieve this. Previous studies have attempted to analyse factors influencing length of stay in mental health units, focussing mostly on patient factors. These models fail to sufficiently explain the variation in duration of inpatient stay. We assess how the type of service delivered by a trust, in addition to patient factors, influences length of stay.Methods: We conducted a retrospective case cohort study in a large inner-city NHS mental health trust for all admissions in a one month period. Data was gathered from electronic notes of 105 patients. Descriptive univariate and bivariate analyses were conducted on the data, with multiple regression analysis conducted on statistically significant data. Results: Short-stay assessment ward admission significantly reduced length of stay. Patients under outpatients or under care co-ordination, admitted through Mental Health Act assessment and formally detained all had longer length of stay. Out of area admissions, locum Consultant care, changing Responsible Clinician and ward transfers all led to longer length of stay. Factors indicating more severe illness such as increased observation level and polypharmacy, as well as diagnoses of psychosis or bipolar disorder were associated with longer duration of stay. Discharges requiring referral to accommodation or rehabilitation led to longer stays. The most significant factors that influenced length of stay were higher observation levels, diagnosis of psychotic illness or bipolar, and discharge to rehabilitation placement. The final model, taking into account all these factors, was able to account for 59.6% of the variability in length of stay.Conclusions: The study backs up existing literature which shows patient-factors have an influence on length of stay. The study also demonstrates that service-level factors have an impact on the duration of stay. This data may be used to inform further studies which may aid provision of inpatient and community services in the future.

Evaluation of Substance Use Disorder Readmission and Length of Hospital Stay in a Major Rehabilitation Center in the Gulf States: a Retrospective Cohort Study

“…Our study indicates that patients with SUDs with recovered discharge status exhibited a higher mean length of hospital stay, potentially indicating that completing the treatment program requires a longer hospital stay. In the present study, the average length of stay for all patients with SUD was 27 days, which is relatively less than that reported in a prior study conducted in acute psychiatric wards in the West, with an average hospital stay of 36 days (Crossley et al, 2020). The long hospital stay can be attributed to the 12-step treatment program established et al-Amal Hospital, which requires the patient to be admitted for 30 days.…”

“…It is well-documented that long-term and heavy users of SUDs might develop psychiatric disorders at some point in their lives (Winkelman et al, 2018). Factors that increase the severity of illness as a psychiatric disorder have been shown to increase the length of stay (Crossley et al, 2020). Thus, in the present study, SUD patients with mental health disorders as a second diagnosis appeared to spend more hospital days than those without mental health disorders.…”

“…The long hospital stay can be attributed to the 12-step treatment program established et al-Amal Hospital, which requires the patient to be admitted for 30 days. This highlights the need to reevaluate the current treatment program and its efficacy on patient outcomes as factors associated with how SUD services impact the length of stay (Crossley et al, 2020). Furthermore, mental health disorders were another predictor of the length of hospital stay.…”

“…Conversely, the length of hospitalization is one of the highest among patients with SUDs (Hines et al, 2014). In the USA, SUD length of stay accounted for approximately 7% of all stays (Heslin et al, 2015), with an average of 6-day stay in non-psychiatric hospitals and 36 days in psychiatric hospitals (Crossley et al, 2020). Moreover, patients with a prolonged length of stay are at an increased risk of acquiring hospital-related infections (Lyketsos et al, 2002).…”

Electronic health records reveal transdiagnostic clinical features and diverse trajectories of serious mental illness

“…Using the framework we developed for extracting clinical phenotypes, we observe that demographic characteristics, indices of overall clinical course, and NLP features across MDD, BD, and SCZ broadly align with expectations from the literature (Table 1 and Supplementary Figure 4): The majority of patients with MDD and BD but not SCZ are female (66.4% and 65.1% vs. 24.3% respectively) 27,28 ; patients with SCZ and BD diagnoses, compared to MDD, are hospitalized significantly more frequently (74.7% and 71.4% vs 56.4% respectively) and have longer hospital stays (median of 14 and 12 vs 8 days) 29 (see Supplementary Table 7 for details on statistical tests performed).…”