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Kaggwa MM, Najjuka MS, Kesande C, Nyemara N, Kule M, Mamum MA, Bongomin F, Ashaba S. Length of stay of hospitalized patients at tertiary psychiatry facilities in Uganda: the role of caregiver's presence. DISCOVER MENTAL HEALTH 2022; 2:15. [PMID: 37861871 PMCID: PMC10501016 DOI: 10.1007/s44192-022-00018-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/22/2022] [Indexed: 10/21/2023]
Abstract
BACKGROUND Whether the presence of caregivers during the hospital stay of patients with mental illness affects the length of hospital stay (LoS) remains inconclusive. AIMS (1) To determine the average LoS and the associated factors, and (2) to determine the role of caregivers' presences during inpatient stay on LoS. METHODS We conducted a cross-sectional study in two hospitals in Uganda; one with caregivers and the other without caregivers between July to November 2020. Mann-Whitney U test was used to compare LoS in the two selected hospitals and linear regression was used to determine factors associated with LoS. RESULTS A total of 222 participants were enrolled, the majority were males (62.4%). Mean age was 36.3 (standard deviation (SD) = 13.1) years. The average LoS was 18.3 (SD = 22.3) days, with patients in a hospital without caregivers having a longer median LoS (i.e., (30 (interquartile range (IQR) = 30) vs. 7 (7) days; χ2 = 68.95, p < 0.001). The factors significantly associated a longer LoS among our study participants included; being admitted in a hospital without caregivers (adjusted coefficient [aCoef]: 14.88, 95% CI 7.98-21.79, p < 0.001), a diagnosis of schizophrenia (aCoef: 10.68, 95 %CI 5.53-15.83, p < 0.001), being separated or divorced (aCoef: 7.68, 95% CI 1.09-14.27, p = 0.023), and increase in money spent during the admission (aCoef: 0.14, 95% CI 0.09-0.18, p < 0.001). CONCLUSION Patients with mental illness in southwestern Uganda have a short LoS (below 28 days), and the stay was much shorter for patients with fulltime caregivers. We recommend caregivers presence during patient's hospital stay to reduce the LoS and minimize healthcare expenditure.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- African Centre for Suicide Prevention and Research, Mbarara, Uganda.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.
| | | | - Claire Kesande
- Butabika National Referral and Teaching Mental Hospital, kampala, Uganda
| | - Novatus Nyemara
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Kule
- Department of Psychiatry, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Mohammed A Mamum
- CHINTA Research Bangladesh, Dhaka, Savar, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Savar, Bangladesh
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Seymour J, Chapman T, Starcevic V, Viswasam K, Brakoulias V. Changing characteristics of a Psychiatric Emergency Care Centre. An eight year follow-up study. Australas Psychiatry 2020; 28:307-310. [PMID: 29737196 DOI: 10.1177/1039856218772252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to report changes in characteristics of admissions to an established Psychiatric Emergency Care Centre (PECC) eight years after its opening. METHOD Key clinical characteristics of admissions to the PECC were documented for 327 patients in 2015 and compared with the 477 patients in 2007, which is when the centre first opened. The characteristics of admission were evaluated using an audit of medical records from June to December in both 2007 and 2015. RESULTS Statistically significant differences (p<0.05) between 2007 and 2015 were: a reduction in the numbers of patients admitted with depression; a reduction in the numbers of patients diagnosed with adjustment disorder; an increase in the numbers of patients diagnosed with borderline personality disorder; a reduction in pro re nata (prn) use, including a reduction in the need for chemical restraint with midazolam and a decrease in the length of admission in the PECC. CONCLUSIONS The significant reduction in aggression, the use of prn medication and the number of people with longer stays within the PECC support the usefulness of PECCs in relation to patient satisfaction and adherence to admission criteria policy. These factors may be considered as indicators of the efficiency of a PECC.
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Affiliation(s)
- Joanne Seymour
- Nurse Practitioner, Nepean Hospital Triage and Assessment Centre - Nepean Hospital, Penrith, NSW, Australia
| | - Tristan Chapman
- Clinical Nurse Consultant, Nepean Hospital Psychiatric Consultation Liaison - Nepean Hospital, Penrith, NSW, Australia
| | - Vladan Starcevic
- Associate Professor, University of Sydney, Sydney Medical School - Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia
| | - Kirupamani Viswasam
- Research Assistant, Nepean Hospital, Department of Psychiatry, Penrith, NSW, Australia
| | - Vlasios Brakoulias
- Senior Lecturer, University of Sydney, Sydney Medical School - Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia
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Kealy-Bateman W, McDonald A, Haber PS, Green T, White B, Sundakov V, O'Cionnaith C, Glozier N. Development of a joint mental-health and drug health assessment unit and short-stay unit. Australas Psychiatry 2019; 27:374-377. [PMID: 31107103 DOI: 10.1177/1039856219848825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There is emerging interest in models of care that focus on assessment and brief inpatient treatment (two to three days) including psychiatric emergency care centre units and short-stay units in Australia. We present the development of a functionally integrated Missenden Assessment Unit and six-bed short-stay unit in the new Professor Marie Bashir Centre at Royal Prince Alfred Hospital in inner-city Sydney. The focus was on collaboration between emergency, drug and alcohol and mental-health services in developing the short-stay unit and Missenden Assessment Unit with joint admission and resource use. We outline the models of care and findings from the 2016 evaluation following the initial two years of operation and consider ongoing challenges. CONCLUSION The Missenden Assessment Unit provides an alternative point of presentation for mental-health drug and alcohol patients. The short-stay unit provides coordinated, therapeutic interventions. The Missenden Assessment Unit/short-stay unit reduced the burden of presentations to the emergency department while providing the opportunity for training and collaboration. Further refinement of the models of care should occur with policy development and via research.
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Affiliation(s)
- Warren Kealy-Bateman
- Clinical Senior Lecturer, University of Wollongong, Wollongong, NSW, and; Senior Staff Specialist Psychiatrist, Department of Psychiatry, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew McDonald
- Director of Clinical Services, Mental Health, Sydney Local Health District, Concord, NSW, Australia
| | - Paul S Haber
- Clinical Director, Drug Health Services, Sydney Local Health District, Camperdown, NSW, and; Professor and Head, Discipline of Addiction Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Tim Green
- Clinical Senior Lecturer, Sydney Medical School, The University of Sydney, Sydney, NSW, and; Senior Staff Specialist, Emergency Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Bethany White
- Postdoctoral Research Associate, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Viktoria Sundakov
- Director, Department of Psychiatry, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Cathal O'Cionnaith
- Registrar, Mental Health, Sydney Local Health District, Camperdown, NSW, Australia
| | - Nicholas Glozier
- Professor of Psychological Medicine, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Hielscher E, Diminic S, Harris M, Castle D, Lee YY, Kealton J, Whiteford H. Impact of the carer on length of hospital stay for mental health: Results from two Australian surveys. Int J Ment Health Nurs 2019; 28:436-447. [PMID: 30246493 DOI: 10.1111/inm.12543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
Informal carers play a vital role in supporting Australians living with a mental illness, including during the acute phases of illness; however, little is known about their impact on length of hospital stay. We aimed to investigate the impact of having a carer and of carer burden on length of hospital stay for mental health. Two Australian datasets were used. Data from the 2010 National Survey of High Impact Psychosis (n = 1825) were used to investigate the impact of having versus not having a carer on length of hospital stay for mental health. Data from the UQ Carer Survey 2016 (n = 105), a convenience sample of mental health carers, were used to investigate the impact of weekly hours of care (a measure of objective carer burden) on length of stay. Multiple logistic regression and correlation analyses were performed to investigate the association between carer status/burden and length of stay. Having a carer was associated with a significantly longer length of hospital stay; however, this relationship was no longer significant after adjusting for diagnosis, global functioning, depressive symptoms, deliberate self-harm, mental health outpatient contacts and type of admission. Weekly hours of care did not significantly impact on length of stay. Patients with carers had poorer functioning which may be related to longer stays. Our analysis was not able to look at subgroups of carers with different needs. Future work is required to determine other components of the admission and discharge process where having a carer is influential.
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Affiliation(s)
- Emily Hielscher
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sandra Diminic
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Meredith Harris
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David Castle
- University of Melbourne and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Yong Yi Lee
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jan Kealton
- Carer Consultant, Gold Coast, Queensland, Australia
| | - Harvey Whiteford
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Abstract
OBJECTIVES This article reviews recent trends in the provision of psychiatric services to the emergency departments of tertiary hospitals in Australia, involving the establishment of specialised in-reach or liaison services as well as various forms of short stay unit attached to emergency departments. The Emergency Psychiatry Service at Flinders Medical Centre, South Australia, is described as a case example. Its specialised models of assessment and clinical care are described, highlighting how these are differentiated from more traditional models in inpatient, community and general hospital consultation-liaison psychiatry. CONCLUSIONS Emergency psychiatry, and in particular the application of specialised psychiatric models of in-reach service and short stay units, is an increasingly important and growing field of psychiatry that warrants further exploration in research. The Emergency Psychiatry Service at Flinders Medical Centre has developed a distinct group of assessment and treatment approaches that exemplifies this growing field.
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Affiliation(s)
- Paul Cammell
- Senior Psychiatrist, Department of Psychiatry, Flinders Medical Centre, Adelaide, SA, Australia
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Antipsychotic Selection for Acute Agitation and Time to Repeat Use in a Psychiatric Emergency Department. J Psychiatr Pract 2016; 22:450-458. [PMID: 27824777 DOI: 10.1097/pra.0000000000000186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Early recognition and treatment of agitated patients is essential to avoid violence in the psychiatric emergency department (ED). Antipsychotics have established efficacy in managing agitation, yet little is known about how the choice of initial antipsychotic impacts time to repeat use and length of stay (LOS) in the psychiatric ED. OBJECTIVE To describe the impact of initial antipsychotic selection on time to repeat use and LOS in the psychiatric ED. METHODS A chart review identified 388 cases in which patients were administered an antipsychotic for agitation in the psychiatric ED between July 1 and August 31, 2014. Time to repeat use and LOS were compared for intramuscular (IM) haloperidol, other IM antipsychotics, and oral second-generation antipsychotics (SGAs) using the Kruskal-Wallis or Wilcoxon-Mann-Whitney test. RESULTS Of the 388 cases, 31% (n=122) required repeat medications. Mean time to repeat use for IM haloperidol was 20.1±18.4 hours, which was not significantly different from mean time to repeat use in the groups receiving other IM antipsychotics or oral SGAs (P=0.35). The mean LOS was 29.7±28.7 hours for IM haloperidol, 30.3±36.9 hours for other IM antipsychotics, and 22.6±28.0 hours for oral SGAs. Significant differences in LOS between repeat and nonrepeat users of IM haloperidol and other IM antipsychotics were observed, but not among those who received oral SGAs. CONCLUSIONS Mean time to repeat use ranged from 14 to 20 hours with IM haloperidol, other IM antipsychotics, and oral SGAs without significant differences in time to repeat use in the 3 different groups. Repeat users of IM antipsychotics had a significantly longer LOS in the ED compared with nonrepeat users of IM antipsychotics. However, patients who were initially administered oral SGAs did not have longer LOS in the ED even if a repeat dose was given.
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