scholarly journals How long is (too) long?

2019 ◽  
Vol 43 (4) ◽  
pp. 151-153
Author(s):  
Birgit Völlm
Keyword(s):  
Length Of Stay ◽  
Mental Disorder ◽  
Patient Group ◽  
Ethical Issues ◽  
Psychiatric Services ◽  
Patient Factors ◽  
Policy Issues ◽  
Forensic Psychiatric ◽  
Restrictive Settings

SummaryForensic psychiatric services care for patients who present with a mental disorder as well as a risk to themselves or others, and have usually been convicted of an offence. Their needs are complex and the length of stay (LoS) in forensic settings is long. LoS is affected by patient factors as well as legal and policy issues. Owing to the considerable economic and ethical issues surrounding lengthy stays in highly restrictive settings, it is crucial that a strategy is developed for how to deal with this patient group.Declaration of interestNone.

scholarly journals The independent patient factors that affect length of stay following hip fractures

2018 ◽  
Vol 100 (7) ◽  
pp. 556-562 ◽  
Author(s):  
T Richards ◽  
A Glendenning ◽  
D Benson ◽  
S Alexander ◽  
S Thati
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Acute Hospital ◽  
Hospital Length Of Stay ◽  
Patient Factors ◽  
Mobility Status

Introduction Management of hip fractures has evolved over recent years to drive better outcomes including length of hospital stay. We aimed to identify and quantify the effect that patient factors influence acute hospital and total health service length of stay. Methods A retrospective observational study based on National Hip Fracture Database data was conducted from 1 January 2014 to 31 December 2015. A multiple regression analysis of 330 patients was carried out to determine independent factors that affect acute hospital and total hospital length of stay. Results American Society of Anesthesiologists (ASA) grade 3 or above, Abbreviated Mental Test Score (AMTS) less than 8 and poor mobility status were independent factors, significantly increasing length of hospital stay in our population. Acute hospital length of stay can be predicted as 8.9 days longer when AMTS less than 8, 4.2 days longer when ASA grade was 3 or above and 20.4 days longer when unable to mobilise unaided (compared with independently mobile individuals). Other factors including total hip replacement compared with hemiarthroplasty did not independently affect length of stay. Conclusions Our analysis in a representative and generalisable population illustrates the importance of identifying these three patient characteristics in hip fracture patients. When recognised and targeted with orthogeriatric support, the length of hospital stay for these patients can be reduced and overall hip fracture care improved. Screening on admission for ASA grade, AMTS and mobility status allows prediction of length of stay and tailoring of care to match needs.

Possible Implications for Bundled Payment Models of Comorbidities and Complications as Drivers of Cost in Total Ankle Arthroplasty

2018 ◽  
Vol 40 (2) ◽  
pp. 210-217 ◽  
Author(s):  
Daniel Cunningham ◽  
Vasili Karas ◽  
James K. DeOrio ◽  
James A. Nunley ◽  
Mark E. Easley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
Patient Factors ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Bundled Payment ◽  
Significance Threshold ◽  
Ed Visits

Background: The Comprehensive Care for Joint Replacement (CJR) model provides bundled payments for in-hospital and 90-day postdischarge care of patients undergoing total ankle arthroplasty (TAA). Defining patient factors associated with increased costs during TAA could help identify modifiable preoperative patient factors that could be addressed prior to the patient entering the bundle, as well as determine targets for cost reduction in postoperative care. Methods: This study is part of an institutional review board–approved single-center observational study of patients undergoing TAA from January 1, 2012, to December 15, 2016. Patients were included if they met CJR criteria for inclusion into the bundled payment model. All Medicare payments beginning at the index procedure through 90 days postoperatively were identified. Patient, operative, and postoperative characteristics were associated with costs in adjusted, multivariable analyses. One hundred thirty-seven patients met inclusion criteria for the study. Results: Cerebrovascular disease (intracranial hemorrhages, strokes, or transient ischemic attacks) was initially associated with increased costs (mean, $5595.25; 95% CI, $1710.22-$9480.28) in adjusted analyses ( P = .005), though this variable did not meet a significance threshold adjusted for multiple comparisons. Increased length of stay, discharge to a skilled nursing facility (SNF), admissions, emergency department (ED) visits, and wound complications were significant postoperative drivers of payment. Conclusion: Common comorbidities did not reliably predict increased costs. Increased length of stay, discharge to an SNF, readmission, ED visits, and wound complications were postoperative factors that considerably increased costs. Lastly, reducing the rates of SNF placement, readmission, ED visitation, and wound complications are targets for reducing costs for patients undergoing TAA. Level of Evidence: Level II, prognostic prospective cohort study.

scholarly journals Facilities for carers of in-patients in forensic psychiatric services in England and Wales

2010 ◽  
Vol 34 (9) ◽  
pp. 381-384 ◽  
Author(s):  
Irene Cormac ◽  
Drew Lindon ◽  
Hannah Jones ◽  
Trevor Gedeon ◽  
Michael Ferriter
Keyword(s):  
Mental Health ◽  
Postal Survey ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
England And Wales ◽  
Mental Health Settings ◽  
Forensic Psychiatric ◽  
Minority Ethnic ◽  
Psychiatric Facilities

Aims and methodA postal survey of forensic psychiatric facilities in England and Wales was undertaken to obtain information about the services provided for carers of in-patients within these services.ResultsForensic psychiatric services vary in the support and facilities provided for carers. Many do not comply with current legislation for carers. Most units informed carers of their rights to have an assessment, but only a minority provided facilities for carers from Black and minority ethnic backgrounds.Clinical implicationsForensic psychiatric services should meet standards for the involvement and support of carers in mental health settings, and comply with legislation for carers.

Preoperative Patient Factors Affecting Length of Stay following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 34 (9) ◽  
pp. 2124-2165.e1 ◽  
Author(s):  
Ajay Shah ◽  
Muzammil Memon ◽  
Jeffrey Kay ◽  
Thomas J. Wood ◽  
Daniel M. Tushinski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Patient Factors ◽  
Factors Affecting ◽  
Total Knee ◽  
Preoperative Patient

Ethical Issues in the Practice of Forensic Psychiatry

1982 ◽  
Vol 10 (1) ◽  
pp. 7-43 ◽  
Keyword(s):  
New York ◽  
Forensic Psychiatry ◽  
Ethical Issues ◽  
Rapid Development ◽  
Panel Discussion ◽  
Special Interests ◽  
Philosophical Perspective ◽  
Psychiatric Setting ◽  
Forensic Psychiatric ◽  
Hospital Center

The recent, rapid development of the practice of forensic psychiatry has led to an increasing awareness of and a growing concern about the ethical issues that inhere in this subspecialty. While some such issues are similar to those found in the general practice of psychiatry (confidentiality, informed consent, etc.), there are aspects of these and other ethical issues which are unique to the practice of forensic psychiatry. On October 16 and 17, 1980, at the annual meeting of the American Academy of Psychiatry and Law held in Chicago, Illinois, a panel discussion concerning ethical issues in forensic psychiatry took place. The chairman was Henry C. Weinstein, M.D., Director, Forensic Psychiatry Services, Bellevue Hospital Center, New York. This panel, made up of two forensic psychiatrists and two philosophers (with special interests in medical ethics), discussed the ethical issues in the practice of forensic psychiatry from a variety of perspectives. A general statement in regard to ethics and forensic psychiatry opened the panel, followed by a series of presentations relating to specific ethical issues, including those which face the forensic psychiatrist practicing in a secure forensic unit, those which arise in the practice of forensic psychiatry with children and adolescents, as well as ethical issues relating to research in forensic psychiatry. A special program for the exploration and teaching of ethical issues, in a clinical forensic psychiatric setting, utilizing a philosopher-in-residence, was described and discussed. The panel presentation was concluded by a commentary from the philosophical perspective.

scholarly journals Ethical issues of long-term forensic psychiatric care

2016 ◽  
Vol 2 (1) ◽  
pp. 36-44 ◽  
Author(s):  
B. Völlm ◽  
P. Bartlett ◽  
R. McDonald
Keyword(s):  
Psychiatric Care ◽  
Ethical Issues ◽  
Forensic Psychiatric

Economic Losses Associated with Chronic Mental Disorder in a Developing Country

1984 ◽  
Vol 144 (5) ◽  
pp. 475-481 ◽  
Author(s):  
Joseph Westermeyer
Keyword(s):  
Mental Disorder ◽  
Mentally Ill ◽  
Rating Scales ◽  
Demographic Data ◽  
Cost Benefit ◽  
Psychiatric Services ◽  
Economic Losses ◽  
Major Mental Disorder ◽  
Wide Variability ◽  
The Cost

SummaryThis study was undertaken in a society without psychiatric services to assess the economic losses associated there with major mental disorder. Such data are important in assessing the cost/benefit of services for major mental disorders.A survey was conducted in 27 representative villages of Laos, each containing about 200–300 people; 35 mentally ill subjects were identified. Data were obtained on expenditure for treatment, loss of productivity, and other economic losses (eg., destruction of property); demographic data and clinical rating scales were also obtained, and compared with economic variables.The data show wide variability in expenditures for treatment, but losses of productivity were consistently high; acute losses, while impressive due to their suddeness and obvious wastefulness, were comparatively small relative to others. Demographic data were not associated with loss in productivity. Certain psychopathological parameters, ie., more psychopathology, less productivity, were inversely correlated with productivity. Psychosocial function scales were strongly and directly correlated with productivity.

Self-discharge by adult Aboriginal patients at Alice Springs Hospital, Central Australia: insights from a prospective cohort study

2013 ◽  
Vol 37 (2) ◽  
pp. 239 ◽  
Author(s):  
Lloyd J. Einsiedel ◽  
Eileen van Iersel ◽  
Robert Macnamara ◽  
Tim Spelman ◽  
Malcolm Heffernan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Length Of Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Past History ◽  
Cultural Safety ◽  
Patient Factors ◽  
Discharge Rates ◽  
Central Australia

Objective. To determine rates and risk factors for self-discharge by Aboriginal medical inpatients at Alice Springs Hospital. Methods. Prospective cohort study. Interviews were conducted in primary language by Aboriginal Liaison Officers, from July 2006 to August 2007. Topics included understanding of diagnosis, satisfaction with services and perceptions of staff and environment. Risk factors for self-discharge were then determined prospectively. Results. During the study period 202 (14.7%) of 1380 patients admitted to general medical units at Alice Springs Hospital, were interviewed. Self-discharge rates for all admissions were significantly lower during the study period than they had been previously (pre-study, mean 22.9 ± standard error 0.3%; study, 17.0 ± 0.2%) (P < 0.001). Most interviewees (73.4%) did not know their reason for admission (73.4%) or estimated length of stay (82.3%). Forty interviewees (19.8%) self-discharged. Mean monthly self-discharge rates differed between the three medical units (Unit A, 13.9 ± 0.3%; Unit B, 17.3 ± 1.37%; Unit C, 20.0 ± 0.4%) (P = 0.005). Multivariable predictors of self-discharge included male sex (hazard ratio (HR) 2.4; 95% confidence interval (CI) 1.1, 5.2), a past history of self-discharge (HR 3.2; 95%CI 1.5, 6), planned transfer to a tertiary referral centre (HR 3.8; 95%CI 1.3–7.4) and a desire to drink alcohol (HR 4.5; 95%CI 1.8–10.2). Conclusions. Physician, institutional and patient factors all contribute to self-discharge. Improving cultural safety may be the key to lowering self-discharge rates. What is known about the topic? Rates of self-discharge by Aboriginal adults in Central Australia are the highest reported worldwide. Previous studies have been retrospective and focussed on patient demographics without addressing the environmental and cultural contexts in which self-discharge occurs. What does this paper add? In this acute care setting, we found a pervasive failure to communicate effectively with Aboriginal patients. Consequently, most patients were unaware of their diagnosis or length of stay. Self-discharge was a common practice; nearly half of all previously admitted patients had self-discharged in the past. We demonstrate that physician, hospital and patient factors all contribute to this practice. Prospectively determined risk factors included the treating medical team, the need for transfer outside Central Australia, and patient factors such as male gender and alcohol dependence. Self-discharge rates fell significantly with Aboriginal Liaison involvement. What are the implications for practitioners? Cross-cultural communication skills must be markedly improved among medical staff caring for this marginalised population. Critical to reducing rates of self-discharge are improvements in institutional cultural safety by involving Aboriginal Liaison Officers and family members. However, persistently high self-discharge rates suggest a need to redirect medical services to a more culturally appropriate community-based model of care.

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