Clinical factors related to admission and release decisions in psychiatric emergency services
ABSTRACT The purpose of the study was to identify important clinical variables that influence admission and release decisions in psychiatric emergency services.
Physicians at four urban psychiatric emergency services rated 465 patients on ten clinical dimensions, including depression and psychosis. Information on five other variables-age, gender, ethnicity, diagnosis, and previous inpatient admission-were extracted from the patients' charts, as was information on case disposition.
Logistic regression produced a model with five variables that significantly predicted admission or release. In order of importance, they were level of danger to self, severity of psychosis, ability to care for self, impulse control, and severity of depression. The model explained 51 percent of the variance in case disposition and correctly classified 84 percent of the cases.
Guidelines addressing the variables that should be considered in making disposition decisions in psychiatric emergency services should be developed. The study found five variables that should be considered for inclusion.
- SourceAvailable from: Alvaro Camacho
[Show abstract] [Hide abstract]
- "To further support this theory, a recent report showed that African Americans tend to receive less psychosocial interventions after being discharged from the hospital after a psychotic episode (Goulding et al. 2010). Without appropriate culturally sensitive services for African Americans, this could perpetuate the ongoing observed cycle of increased grave disability, psychosis and repetitive hospitalizations (Way and Banks 2001). Future interventions need to explore other factors that may be associated with ethnicity and decompensation of psychiatric symptoms in rural border communities. "
ABSTRACT: Ethnic minorities from disadvantaged socioeconomic backgrounds report increased utilization of mental health emergency services; however findings have been inconsistent across ethnic/racial groups. In this study we describe patients who present to a rural crisis unit in Southern California, examine rates of psychiatric hospitalizations across ethnic/racial groups, and investigate factors that are associated with increased psychiatric hospitalizations in this sample. This is a retrospective study of 451 racially and ethnically diverse patients attending a crisis unit in Imperial County, California. Chart review and data abstraction methods were used to characterize the sample and identify factors associated with psychiatric crises and subsequent hospitalizations. The sample was predominantly Latino/Hispanic (58.5%). Based on chart review, common psychosocial stressors which prompted a crisis center visit were: (a) financial problems; (b) homelessness; (c) partner or family conflict; (d) physical and health problems; (e) problems at school/work; (f) medication compliance; (g) aggressive behavior; (h) delusional behavior; (i) addiction and (j) anxiety/depression. Bivariate analyses revealed that Hispanics had a disproportionately lower rate of psychiatric hospitalizations while African Americans had a higher rate. Multivariate analyses which included demographic, clinical and psychosocial stressor variables revealed that being African American, having a psychotic disorder, and presenting as gravely disabled were associated with a higher likelihood of hospitalization while partner/family conflict was associated with a lesser likelihood in this rural community. These data elucidate the need for longitudinal studies to understand the interactions between psychosocial stressors, ethnicity and social support as determinants of psychiatric hospitalizations.Community Mental Health Journal 10/2010; 48(2):133-7. DOI:10.1007/s10597-010-9350-0 · 1.03 Impact Factor
- Fortschritte der Neurologie · Psychiatrie 01/2002; 70(4):192-197. DOI:10.1055/s-2002-24641 · 0.76 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Mental health care reform has brought an increasing emphasis on community care, with concomitant reductions in inpatient psychiatric resources. Hospitalization remains a necessary and integral component of the mental health care system, but it is taking on a more specialized role. Examining the circumstances in which hospitalization is indicated can help clarify emergency psychiatric practices and determine whether patients' needs are being met within this changing environment. This pilot study examined the impact of selected patient and contextual characteristics on the decision to admit patients to inpatient psychiatric units and assessed the utility of the Severity of Psychiatric Illness (SPI) scale for monitoring clinical practice in emergency psychiatric services. Crisis workers in two emergency psychiatric services crisis teams in Toronto, Canada, used the SPI in the assessment of 205 visitors to the services during the winter of 1998-1999. Contextual characteristics, including bed availability, service site, and the admitting physician's level of training, were recorded. Multivariate logistic regression was used to assess the relative contribution of patient and contextual variables in the admission decision. The severity of axis I symptoms and difficulties with self-care were significantly associated with the decision to admit. Site, bed availability, and the admitting physician's level of training did not appear to be associated with clinical decisions. Patients with the most need are being admitted to inpatient units despite significant systemic pressures on inpatient services. The SPI is a useful and discriminating tool for evaluating clinical practice in emergency services.Psychiatric Services 01/2003; 53(12):1586-91. DOI:10.1176/appi.ps.53.12.1586 · 1.99 Impact Factor