Why are some patients admitted to psychiatric hospital while others are not? A study assessing risk during the admission interview and relationship to outcome

Abstract

The aim of this study was to determine what patient characteristics are used to decide whether a patient is or is not admitted to a psychiatric hospital, and what happens to those not admitted. A further aim was to determine if high levels of risk on admission predict seclusions, length of stay, or readmission within 28 days. Data were collected prospectively on consecutive presentations to an admission office via case notes and electronic databases. Eighty percent (100/127) of the adults presenting to the admission office over a typical month were admitted to hospital. Patients were more likely to be admitted if they were experiencing psychosis or exacerbation of schizophrenia, referred by other doctors or mental health teams, had a legal reason for referral, or if they were homeless. There was no association between risk for violence or suicide and seclusion rates, length of stay, or being readmitted within 28 days. It was reassuring to find that 85% of those not admitted were referred to other mental health providers, and none required admission over the following month. This study found high rates of seclusion and readmissions within 1 year, which requires further study to find strategies to reduce these rates.

Clinical profile of people referred to mental health nurses under the Mental Health Nurse Incentive Program

“…The finding is in keeping with previous work which suggests that the main reasons for admission to acute care include suicidality, depression, deterioration of existing serious mental illness, elation, and self‐harm or risk of self‐harm (Hunt et al . ). In a recent UK study, risk of self‐harm emerged as the most crucial factor for admission to inpatient care (Brooker et al .…”

Preventing Suicide among Inpatients

“…T he clinical decision to admit a psychiatric patient to hospital is primarily based on judgment about acuity, severity, and danger to self or others. [1][2][3][4][5][6][7][8][9][10] Patient safety is a prerequisite sine qua non for admission to a psychiatric inpatient unit, whether in a general or psychiatric hospital. Clearly, in supporting such an admission, the patient's family and friends expressly assume that the patient will be protected from harm, including harm to the self, and that this protection will extend for some reasonable time into the future, postdischarge.…”

“Factors predicting admission of psychiatric emergency contacts after presenting to the emergency department – results of a regression analysis.”

“…Consistencies in predictors of inpatient psychiatric admission include prior psychiatric treatment (11,28,7), presence of legally initiated admissions against the patient's will (7,21), and physician referral (22,7,21,12). The psychiatric emergency syndromes from the German guideline Emergency Psychiatry (9) are also predictive, supporting the validity of the syndromes.…”

“…However, despite differences in study designs and country-speci c differences in health care systems, some predictors are described repeatedly. These include the presence of suicidality and a diagnosis of schizophrenia (11,12,(17)(18)(19)(20), as well as the presence of aggressiveness, impulsivity, and danger to others (14,21,16,20). In contrast, diagnoses such as anxiety panic disorder are more likely not to result in inpatient admission (7).…”