A general hospital psychiatric unit inpatient facility

Summary Patients admitted to the inpatient ward of a psychiatric unit in a general hospital have been studied with regard to their clinical characteristics, reasons for admission and discharge patterns. The results indicate that patients are most often admitted for the management of acute disturbance and detailed diagnostic evaluation and they are discharged in a semi-improved state. Implications of such a service pattern are discussed.     

Patients' comments on psychiatric inpatient treatment experiences: Patient-therapist relationships and their implications for treatment outcome

Only few researchers pay systematic attention to what patients may have to say about their treatment experience during psychiatric hospitalization.This study not only delineates the various therapeutic aspects of an open psychiatric inpatient unit based on the patients' comments, but also attempts to correlate the data with the objective outcome of treatment rated clinically by the therapists and independently by the author. Positive patient-therapist relationship has been found to be the most significant factor correlated closely with the treatment outcome. The correlation may support the relevance of the patients' comments regarding subjectively perceived therapeutic benefits vs. objective actual benefits.The author wishes to thank Dolores Millan, B.A., of the Research Department of the Long Island Jewish-Hillside Medical Center, for her assistance in compiling and evaluating the statistical data.     

Predictors of outcome of short-term child psychiatric inpatient treatment

In this study, 85 children were prospectively followed after discharge from short-term inpatient treatment. Outcome was defined as functioning within normal range at the follow-up or as improvement in the child's behavior problems. Rutter Parent's Questionnaire was used as a measure on admission and at the 5-month follow-up after discharge. The child's more frequent individual behavior problems, antisocial behavior and disengaged family interaction on admission predicted both functioning outside normal range and less improvement at follow-up. Previous treatment because of developmental or behavioral problems and hyperkinetic symptoms on admission predicted functioning outside normal range. Parent's previous psychiatric hospital treatment was negatively associated with improvement. Pure emotional disorder predicted normal range functioning at follow-up. The child's age, gender, place of treatment and length of short-term treatment were not related to outcome. The results also stress the importance of taking into account both parents' and teachers' evaluations on admission.     

The psychiatric inpatient unit in the general hospital: clinical demography

Data from the University of Iowa Psychiatric Hospital are consistent with national trends. Inpatients tend to be young, female, and have psychotic rather than non-psychotic disorders. Women were significantly older than men at admission for most psychiatric disorders. During the past 20 years, length of stay has dropped by over 50%, while admissions have almost trebled and re-admissions doubled. Historic trends are reviewed and clinical implications are discussed.     

Factors affecting psychiatric inpatient hospitalization from a psychiatric emergency service

Objective

As a gateway to the mental health system, psychiatric emergency services (PES) are charged with assessing a heterogeneous array of short-term and long-term psychiatric crises. However, few studies have examined factors associated with inpatient psychiatric hospitalization following PES in a racially diverse sample. We examine the demographic, service use and clinical factors associated with inpatient hospitalization and differences in predisposing factors by race and ethnicity.

Method

Three months of consecutive admissions to San Francisco’s only 24-h PES (N = 1,305) were reviewed. Logistic regression was used to estimate the associations between demographic, service use, and clinical factors and inpatient psychiatric hospitalization. We then estimated separate models for Asians, Blacks, Latinos and Whites.

Results

Clinical severity was a consistent predictor of hospitalization. However, age, gender, race/ethnicity, homelessness and employment status were all significant related to hospitalization. Alcohol and drug use were associated with lower probability of inpatient admission, however specific substances appear particularly salient for different racial/ethnic groups.

Discussion

While clinical characteristics played an essential role in disposition decisions, these results point to the importance of factors external to PES. Individual and community factors that affect use of psychiatric emergency services merit additional focused attention.     

History of the general hospital psychiatric inpatient unit. 1947 to 1986

Thirty-five years ago, the Mount Sinai unit was considered the state of the art for inpatient psychiatry. Now, short-term hospitalization, active management techniques, and quick dispositions are the practice. At the rate at which neurophysiology and psychiatry are expanding, I have to anticipate that inpatient psychiatric care will again change radically, and long before another 35 years. I doubt that the psychiatric unit of today that I have described will still be recognizable in 10 years.     

Changing patterns of psychiatric inpatient care in a university general hospital.

The authors describe the changing patterns of psychiatric inpatient care in a university hospital. Patients are shortening their hospital stay and are traveling fewer miles from their homes to the hospital. Increasing numbers of blacks, men, and low-income persons are being treated. In addition, the percentage of patients with neuroses and transient situational disturbances has decreased, while the percentage of those with personality and behavior disorders has increased. The authors discuss the implications of these changes, which benefit both patients and the education of students.     

Characteristics and post-hospital perceptions of patients refusing inpatient treatment in a South African general hospital psychiatric unit

This paper explores characteristics and post-hospital perceptions of patients who refused general hospital psychiatric inpatient treatment in a relatively young unit. It was found that after an initial significant increase of up to 9.6% per year in these patients, the average for the 6-year period studied was 6.2% of all admissions. Most of the patients were single or divorced, not gainfully employed, refused hospital inpatient treatment within the first day after admission and were significantly younger than the controls. Substance use, adjustment and personality disorders predominated, and most of the patients were dissatisfied with some aspect of their treatment. Less than half the patients had a positive attitude towards at least one staff member. Results are discussed within the context of understanding the decision of such patients, in an attempt to deal with the problem and with reference to a consultation-liaison approach.     

Deinstitutionalization and the private general hospital inpatient unit: implications for clinical care

Deinstitutionalization has led to a rapid shift from reliance on state hospitals to use of community-based inpatient psychiatric services. While these inpatient units were initially envisioned as an integral part of the community mental health system, a number of sociopolitical and clinical pressures have caused general hospitals to respond to their new responsibilities in different ways. The authors review trends in deinstitutionalization, the diverging interests of public and private general hospitals, and problems in patient care that result. Based on a discussion of how Beth Israel Hospital, a nonprofit private general hospital in Boston, has dealt with such issues, they describe adaptive responses in four areas: admission criteria, patient management approaches, aftercare planning, and staff training.     

Day treatment for alcoholism in a general hospital psychiatric service

In this paper a time limited, cost effective day treatment program for alcoholics, and characteristics of patients entering this treatment program, are described. The advantages of this day treatment program are discussed with special emphasis on its relationship with other community service agencies, with the community at large and, with a General Hospital Mental Health service, of which it is a part. The implications for planning cost effective treatment services for alcoholics are discussed.     

Health service aspects of psychosomatic inpatient treatment in a general hospital

The study objective is to outline basic aspects of medical care service structure in the fields of psychosomatic medicine in a clinical acute-care setting. A total of 216 inpatients in a psychosomatic ward of a general hospital were investigated during a 32 months period using a retrospective study design. Referring physicians and clinics along with referral procedures, the waiting period, teamwork with other clinics, as well as patient and therapy characteristics are described. According to provisions of outpatient psychosocial care, general practitioners refer the majority of the inpatients (55 %), followed by other clinics (25 %) and psychosomatic and psychiatric outpatient specialists (20 %). An outpatient department along with a psychosomatic C-L service are key elements for a psychosomatic department to ensure coordination of the referral procedure. The average waiting period lasts 21 days, the average length of stay is 48 days. 60 % of the inpatients show somatic and psychiatric co morbidity. A psychopharmacological treatment has to be taken into consideration along with multi-modal psychotherapy in a third of all patients.     

Guidelines for acute inpatient psychiatric treatment review

Inpatient psychiatric care accounts for a major part of the health care dollars spent for mental illness. In this article the authors review the history and literature behind the process of psychiatric peer review and quality assurance and discuss the development of standard criteria for admission to the hospital. These criteria include (1) imminent danger to oneself and others, (2) acute impairment of ability to perform activities of daily life, (3) impulsive or assaultive behavior, and (4) management of withdrawal states. The authors then present an outline of the typical course of the hospital stay. Finally, through a series of questions, criteria for continued stay on an acute care unit are indicated. The essential criterion is medical necessity based on a standard of severity of illness and intensity of treatment required. Criteria for admission, a sense of the typical course of the hospital stay, and criteria for continued stay then become the relevant issues for psychiatric peer review and quality assessment.     

Enhancing treatment team process through mindfulness-based mentoring in an inpatient psychiatric hospital

The authors investigated changes in treatment team functioning in an adult inpatient psychiatric hospital after the implementation of a mindfulness-based mentoring intervention. Using a multiple baseline across treatment teams design, the authors assessed levels of functioning of three treatment teams using a 50-item rating scale and then introduced mindfulness-based mentoring successively across the treatment teams. Following intervention, four follow-up assessments at 3-month intervals were undertaken to assess the durability of the enhanced treatment team functioning levels in the absence of mentoring. Results showed that with the introduction of mindfulness-based mentoring, treatment team performance was enhanced, patients'attendance at therapeutic groups and individual therapy sessions was maximized, and patient and staff satisfaction with treatment team functioning was substantially increased, with patient satisfaction showing greater gains than staff satisfaction. Mindfulness-based mentoring may be an efficient and effective intervention for enhancing and maintaining the performance of treatment teams in adult psychiatric hospitals.     

Overcontrolled children and outcome of short-term psychiatric hospitalization

The psychological changes exhibited by 26 children were examined over a three-month psychiatric hospitalization. No significant change was exhibited on 13 behavior factors of the Devereux Child Behavior (DCB) rating scale. However, evaluation of the mother-child interaction indicated that children who were over-controlled by their mothers showed deficits in social competence; those same children exhibited therapeutic gains in their social relationships. Thus, while hospitalization may be of limited benefit to child psychiatric patients as a group, it may be therapeutic to an overcontrolled and socially inept subgroup of children.