Replacing revolving door: a collaborative approach to treating individuals in crisis.

Christiana Care Health System, Wilmington, DE 19809, USA.
Journal of Psychosocial Nursing and Mental Health Services (Impact Factor: 0.72). 07/2008; 46(6):24-32.
Source: PubMed


The Crisis Assessment and Psychiatric Emergency Services (CAPES) unit was designed to improve the quality of psychiatric treatment, contain costs, and provide relief to overburdened psychiatric inpatient and emergency services in Delaware. This innovative program is the result of collaboration between public and private agencies to treat individuals in crisis. The myriad factors that contributed to a broken system and instigated Delaware's search for a solution are discussed in this article. The CAPES unit has resulted in improved communication among providers, decreased committal rates, better linkage to appropriate levels of care, increased safety, and improved coordination of services. Clinical implications for nursing practice include providing more holistic care in a safer environment.

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    • "Il est donc probable qu'elles recherchent de l'aide extérieure, auprès de différents professionnels, plutôt que de puiser dans leurs ressources internes pour faire face à la crise. Ainsi, un enjeu clinique important en intervention de crise auprès des personnes ayant un trouble de santé mentale consiste à travailler de concert avec les autres professionnels offrant des suivis de psychothérapie (Lauer et Brownstein, 2008 ; Renaud, 2004). Une analyse plus spécifique de la réponse à la crise des personnes ayant des troubles graves de santé mentale suggère que ces dernières requièrent des services cliniques intensifs et encadrés (Ruchlewska et al., 2009). "

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    ABSTRACT: AIM. To study social, demographic, clinical, and forensic profiles of frequently re-hospitalized (revolving-door) psychiatric patients. METHODS. The study included all patients (n=183) who were admitted to our hospital 3 or more times during a 2-year period from 1999 through 2000. We compared these patients to 2 control groups of patients who were admitted to our hospital in the same period. For comparison of forensic data, we compared them with all non revolving-door patients (n=1056) registered in the computerized hospital database and for comparison of medical and clinical data we compared them with a random sample of non revolving-door patients (n=98). The sample was sufficiently large to yield high statistical power (above 98%). We collected data on the legal status of the hospitalizations (voluntary or involuntary) and social, demographic, clinical, and forensic information from the forensic and medical records of revolving-door and non revolving-door patients. RESULTS. In the period 1999-2000, 183 revolving-door patients accounted for 771 (37.8%, 4.2 admissions per patient) and 1056 non revolving-door patients accounted for 1264 (62.5%, 1.2 admissions per patient) of the 2035 admissions to our hospital. Involuntary hospitalizations accounted for 23.9% of revolving-door and 76.0% of non revolving-door admissions. Revolving-door patients had significantly shorter mean interval between hospitalizations, showed less violence, and were usually discharged contrary to medical advice. We found no differences in sex, marital status, age, ethnicity, diagnoses, illegal drug and alcohol use, or previous suicide-attempts between the groups. CONCLUSIONS. Revolving-door patients are not necessarily hospitalized for longer time periods and do not have more involuntarily admissions. The main difference between revolving-door and non revolving-door patients is greater self-management of the hospitalization process by shortening the time between voluntary re-admission and discharge against medical advice.
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