scholarly journals Length of stay in a home treatment team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S249-S249
Author(s):  
Mudasir Firdosi ◽  
Nicole Gill ◽  
Dieneke Hubbeling
Keyword(s):  
Length Of Stay ◽  
Marital Status ◽  
Employment Status ◽  
Electronic Record ◽  
Home Treatment ◽  
Psychiatric Ward ◽  
Referral Source ◽  
Treatment Team ◽  
Record System ◽  
The Mean

AimsThe aims were to establish the mean length of stay (LOS) in the Wandsworth home treatment team (HTT), and to identify which variables were associated with LOS. We hypothesised that the variables that are routinely collected via the electronic record system were associated with the LOS.BackgroundPsychiatric HTT's have been set up in all NHS trusts in England. These 24-hour community health services exist to assess and manage patients during a crisis, who would otherwise be admitted to an acute psychiatric ward. HTT's also allow inpatients to be discharged sooner, as their treatment can continue in the community. Currently, research into predictors of LOS in HTT's is limited.Researchers have been exploring whether LOS in psychiatric inpatients can be predicted, but no consistent pattern has emerged. This suggests that LOS is mainly determined by the local service organisation, and the individual circumstances of the patients.MethodRoutinely collected data about all patients under the care of the Wandsworth HTT during the financial year 2018/2019 were used. Only the first admission per individual was considered. Admissions lasting less than 2 days, or more than 42 days were excluded. This is on the basis that those with a very short LOS had not consented to being treated at home, and those with a very long LOS were due to administrative errors. This resulted in a total of 664 admissions being included in the study. The available data for analysis included age, gender, diagnosis, HoNOS cluster, ethnicity, nationality, religion, marital status, referral source, employment status, accommodation status, and accommodation type. The data were analysed in SPSS version 25 using ANOVA, independent samples T-test, and Pearson's correlation.ResultThe mean LOS in the Wandsworth HTT was 14.28 days (standard deviation: 8.57). LOS was positively skewed, with a median LOS of 13 days, but 46.5% of admissions had a LOS longer than this. None of the variables (age, gender, diagnosis, HoNOS cluster, ethnicity, nationality, religion, marital status, referral source, employment status, accommodation status, and accommodation type) had a significant association with LOS, but there was a trend for referral source and accommodation type.ConclusionThe results from this study suggest that LOS cannot be consistently predicted in the Wandsworth HTT from the routinely collected variables, and that it is the specific circumstances of individual patients that determine their LOS.There was no external funding for this study.

A Discriminant Analysis of Committed and Voluntary Psychiatric Patients

1986 ◽  
Vol 14 (1-2) ◽  
pp. 159-176 ◽  
Author(s):  
Robert A. Nicholson ◽  
Joseph M. Horn
Keyword(s):  
Discriminant Analysis ◽  
Length Of Stay ◽  
Marital Status ◽  
Employment Status ◽  
Cross Validation ◽  
Psychiatric Patients ◽  
Maximum Benefit ◽  
Education And Employment ◽  
Double Cross

Eleven background, diagnostic, and hospitalization characteristics were used to discriminate committed and voluntary psychiatric patients in a double cross-validation design. Diagnosis was more important than individual social and status resources (race, marital status, education, and employment status) in discriminating the two groups of patients. Further, characteristics of hospitalization (length of stay, percentage of patients receiving maximum benefit from treatment, and frequency of discharge referrals) did not contribute significantly to discrimination of the two groups, suggesting that committed and voluntary patients did not differ with regard to the adequacy or effectiveness of treatment in the hospital.

scholarly journals Indicators of early hospitalization decision to shorten emergency department length of stay of suicide attempters

2020 ◽  
Author(s):  
Hye Jin Kim ◽  
Duk Hee Lee
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Psychiatric Ward ◽  
Operating Characteristics ◽  
Psychiatric Admission ◽  
Suicide Attempters ◽  
Tertiary Teaching ◽  
The Mean

Abstract Background Suicide attempters contribute to a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before committing suicide. The emergency department (ED) is the first location where suicide attempters are brought. This study investigated the factors associated with early hospitalization decisions to determine the criteria for patient hospitalization rather than psychiatric ward admission and identify measures to shorten ED length of stay (LOS). Methods This study included suicide attempters (age ≥19 years) who visited the EDs at two tertiary teaching hospitals between March 2017 and April 2020. Results A total of 414 in the hospitalization and 1,346 in the discharge groups patients were included. The mean age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalization and discharge groups (p <0.001). The mean ED LOS was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalization and discharge groups, respectively. In the hospitalization group, the odds ratio and confidence interval for age (1.017, 1.008–1.026), sex (male) (1.787, 1.127–2.515), consciousness (2.330, 1.653–3.266), and the Risk-Rescue Ratio Scale (RRRS) (1.273, 1.242–1.304) were calculated. A receiver operating characteristics analysis of RRRS for the decision to hospitalize suicide attempters showed a cut-off value of 42, with sensitivity, specificity, and area under the curve of 85.7%, 85.5%, and 0.924, respectively.Conclusion For suicidal attempters in the ED, the decision on medical hospitalization rather than psychiatric admission should be based on their level of consciousness and the RRRS to reduce ED LOS and crowding.

scholarly journals Impact of Telemedicine Tools on Record Keeping and Compliance in Haemophilia Care

2019 ◽  
Vol 39 (04) ◽  
pp. 347-354 ◽  
Author(s):  
A. Banchev ◽  
G. Goldmann ◽  
N. Marquardt ◽  
C. Klein ◽  
S. Horneff ◽  
...  
Keyword(s):  
Age Groups ◽  
Electronic Record ◽  
Home Treatment ◽  
Factor Vii ◽  
Record System ◽  
Record Keeping ◽  
Explorative Study ◽  
Bleeding Episodes ◽  
Data Validity ◽  
Electronic Record System

Background Record keeping is integral to home treatment for haemophilia. Issues with paper diaries include questionable compliance, data validity and quality. Implementation of electronic diaries (e-diaries) in haemophilia patients could improve documentation of home treatment. Aim This article evaluates the effects of an e-diary, Haemoassist, on recording and patient compliance with therapy. Patients and Methods An explorative study was used to assess the sequential use of paper diaries and e-diaries by 99 patients with severe haemophilia A or B and 1 with severe factor VII deficiency. Median age was 41 years. Information was obtained from paper records for 3 years preceding the introduction of an electronic record system and the first 6 to 12 months of Haemoassist use. Data from the 3-year period were averaged. Missing data for rounded 12 months of e-diary use were extrapolated to correspond to a full year. Results Enhancement of 23% in record delivery was observed for the period of Haemoassist use (p = 0.013). Twenty-one percent increase in patients’ compliance for data reporting (from 65% 35 to 86% 22, p = 0.003) and 16% increase for documentation of bleedings (from 68 to 84% of patients, p = 0.01) were detected. Compliance to prescribed therapy of patients for the whole studied period improved by 6% (from 82% ± 29 to 88% ± 25, p = 0.05). Major advances were demonstrated predominantly in the age groups of between 13 and 20 and 21 and 40 years. Conclusion e-Diaries' use enables improved recording of information about patients' home treatment and bleeding episodes. Enhanced compliance with therapy may be a further benefit.

scholarly journals 446 - Persistent Delusional Disorder (Late Paraphrenia) - An innovative and cost effective clinical model in the community by older adult‘s mental health crisis and home treatment team

2020 ◽  
Vol 32 (S1) ◽  
pp. 165-166
Author(s):  
Sabarigirivasan Muthukrishnan ◽  
Kate Hydon
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Health Professionals ◽  
Care Delivery ◽  
Average Length ◽  
Home Treatment ◽  
Treatment Team ◽  
Model Of Care ◽  
Average Length Of Stay ◽  
Safe Care

AimsTo review the various available clinical models of care delivery for patients with persistent delusional disorder (PDD) in community and economically evaluate the REACT model of safe care delivery- REACT’s Assertive and Prudent- Model of Safe Care (RAP–MoSC).MethodsREACT (Response Enhanced Assessment Crisis and Home Treatment Team) is the only bespoke crisis and home treatment team for older adults with mental health problems in the whole of Wales available only for the residents of Cardiff and Vale of Glamorgan through Cardiff and Vale University Health Board..It was set up on 28 February 2012. The cases of PDD in REACT service since its inception to 31 Dec 2016 were studied in relation to the assertive and prudent health care model. The economic evaluation of this service model for PDD patients was studied in detail.Results of the studyThe RAP-MoSC model is economically effective in avoiding patients getting admitted to hospital under Mental Health Act by managing them safely in the community.During the period between 28 February 2012 and 31 December 2016 there were 44 patients with a diagnosis of PDD in REACT’s case load. Only 3 patients got admitted to mental health assessment ward with the average length of stay period of 120 days. 41 patients were safely managed in the community with REACT with an average length of stay period of 21 days in REACT. A PDD patient will cost NHS £21,000 if admitted to a mental health bed. If the patient is managed in the community with RAP-MoSC model of care the cost will be £1533. REACT saved £793,548 by avoiding 41 PDD patients being admitted into hospital during an episode of delusional intensification in the period February 2012 to December 2016. PDD patients need under the RAP-MoSC model a bespoke MDT approach with better communication between secondary mental health and primary care services. Assertive and Prudent Clinical leadership is needed to sustain the RAP-MoSC in the community. Clinical reflections of this model of care will be presented in the conference.ConclusionsOn reflection REACT found that the key points in working with PDD are; Using a ‘foot in the door approach’Mental health professionals introducing themselves as Health professionalsRemote prescribing

scholarly journals Utilization of an Evening/Night Hospital: First Two Years of Operation

1977 ◽  
Vol 22 (7) ◽  
pp. 335-340
Author(s):  
William D. Ratcliffe ◽  
G. William Nixon ◽  
Ronald J. Dyck ◽  
Hassan F. A. Azim
Keyword(s):  
Length Of Stay ◽  
Marital Status ◽  
Psychiatric Care ◽  
Average Length ◽  
Psychiatric Patients ◽  
Previous Treatment ◽  
Referral Source ◽  
Average Length Of Stay

This study examined the utilization of an integrated evening/night hospital by 234 psychiatric patients referred to the hospital during its first two years of operation. Neither age, sex, marital status, referral source or diagnosis were related to utilization. However, patients whose previous treatment involved traditional psychiatric care, either inpatient or outpatient, were less frequently admitted and less likely to complete the program once admitted, than were those patients reporting either day hospitalization or no treatment prior to their admission. There were steady increases in the number of referrals, number of different referring agents, average length of stay and average daily census as the program matured during the first two years of operation. While these data indicated an increase in the utilization of the evening portion of the program, there was a commensurate decrease in the utilization of the night portion of the program. As a result, the provision of overnight accommodation has been discontinued altogether.

Day Hospital Approach to Uncomplicated Vaso-Occlusive Crises in Children with Sickle Cell Disease.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5172-5172
Author(s):  
Jean L. Raphael ◽  
Aditi Kamdar ◽  
Brigitta U. Mueller
Keyword(s):  
Sickle Cell Disease ◽  
Length Of Stay ◽  
Sickle Cell ◽  
Inpatient Care ◽  
Home Treatment ◽  
Return Rate ◽  
Day Hospital ◽  
Cell Disease ◽  
Medical Needs ◽  
The Mean

Abstract Day hospital management for patients with sickle cell disease experiencing uncomplicated vaso-occlusive pain crises has been described in adult populations as an alternative care delivery system. To date, there are no published studies addressing the utility of this model in pediatric populations. We retrospectively studied all admissions to the Day Hospital at the Texas Children’s Sickle Cell Center since its inception in 2000. A Day Hospital admission was defined as a minimum of two consecutive days of aggressive pain management as an outpatient, including intravenous hydration and analgesics, supported by home treatment over night with oral analgesic and anti-inflammatory agents. We gathered data on demographics, sickle cell genotype, incoming pain scale, provider type (physician versus nurse practitioner), home treatment with narcotics prior to presentation, average daily dose of narcotics administered during admission, length of stay, admission charges, return rate to the emergency department within 48 hrs, and transfer rate from Day Hospital to inpatient care. A total of 35 patients accounted for 80 visits during the study period (2000–2006). Approximately 83% of patients had sickle cell anemia (HbSS). The mean baseline hemoglobin for patients was 9.1 g/dl. Patients were seen equally by physicians and nurse practitioners. Approximately 93% of visits were preceded by home narcotic use within 24hrs of presentation. The mean incoming pain score was 7.9 on a scale from 1 to 10. The mean length of stay was 2.4 days. The return rate for emergency care within 48 hours was 6%. Approximately 40% of patients admitted to the Day Hospital were transferred to inpatient care for unresolved pain or increasing medical needs. We conclude that a dedicated Day Hospital facility has the potential to provide patient-centered, effective, and timely management of vaso-occlusive crises in children as well as adults. It may serve as an alternative to emergency and inpatient care for children with mild to moderate pain. Future studies should compare day hospital care to inpatient hospitalization for differences in length of stay, cost, patient satisfaction, and quality of life.

Aktivitätskonzentration der vom Personal einer Radiojodtherapiestation eingeatmeten Luft

1987 ◽  
Vol 26 (03) ◽  
pp. 143-146 ◽  
Author(s):  
H. Fill ◽  
M. Oberladstätter ◽  
J. W. Krzesniak
Keyword(s):  
Nuclear Medicine ◽  
Length Of Stay ◽  
Activity Concentration ◽  
Threshold Value ◽  
Whole Body ◽  
Therapeutic Activity ◽  
External Radiation ◽  
Oral Application ◽  
Exhaled Air ◽  
The Mean

The mean activity concentration of1311 during inhalation by the nuclear medicine personnel was measured at therapeutic activity applications of 22 GBq (600 mCi) per week. The activity concentration reached its maximum in the exhaled air of the patients 2.5 to 4 hours after oral application. The normalized maximum was between 2 • 10−5 and 2 • 10−3 Bq-m−3 per administered Bq. The mean activity concentration of1311 inhaled by the personnel was 28 to 1300 Bq-m−3 (0.8 to 35 nCi-rrf−3). From this the1311 uptake per year was estimated to be 30 to 400 kBq/a (x̄ = 250, SD = 50%). The maximum permitted uptake from air per year is, according to the German and Austrian radiation protection ordinances 22/21 µiCi/a (= 8 • 105 Bq/a). At maximum 50% and, on the average, 30% of this threshold value are reached. The length of stay of the personnel in the patient rooms is already now limited to such an extent that 10% of the maximum permissible whole-body dose for external radiation is not exceeded. Therefore, increased attention should be paid also to radiation exposure by inhalation.

Dermatology in primary care: an audit of the proportion of patients who present to general practice with a dermatological problem that could be self-managed

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711053
Author(s):  
Luamar Dolfini ◽  
Yogesh Patel
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Acne Vulgaris ◽  
Clinical Information ◽  
Electronic Record ◽  
Self Management ◽  
Considerable Proportion ◽  
Dry Skin ◽  
Record System ◽  
Common Skin

BackgroundA considerable proportion of GPs’ workload is dermatological. It is important to investigate what common skin conditions encountered in primary care can be self-managed, in an effort to alleviate the burden on primary care.AimThe purpose of the audit was to identify the proportion of consultations that are dermatological in nature and analyse potential for self-management by patients.MethodData was collected using the patient electronic record system (EMIS) in general practice. A search was made for all consultations from the 17 April to 15 May 2019, which included all new presenting complaints that were dermatological in nature. The criteria for self-management included advising over the counter (OTC) medication or reassurance. On the other hand, a case was deemed not self-manageable if prescription only medication (POM) was prescribed or if a referral to dermatology was made.ResultsThere were a total of 2175 consultations, where 246 (11.31%) cases were dermatological. Of the 246, 80 cases (32.5%) could be self-managed. There were 46 different dermatological presenting complaints of which the 5 most common included: rash (51 cases), dermatitis (44 cases), acne vulgaris (13 cases), moles (12 cases), dry skin (11 cases). None of the acne or moles cases could be self-managed, whereas 23%, 68.2%, 72.7% of rashes, dermatitis, and dry skin cases, respectively, could be self-managed.ConclusionCertain dermatological conditions have more potential for self-management than others. Research into teledermatology as a means of addressing patient concern and providing clinical information is important in order to reduce unnecessary consultations.

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