Need analysis for a new high acuity medical psychiatry unit: which patients are considered for admission?

Defining Vision and Mission of a Medical Psychiatry Unit (MPU) for Older Adults: A Focus Group Study

This study aims to determine the vision and mission of an academic hospital's medical psychiatry unit (MPU) that exclusively treats geriatric patients. All healthcare providers working at an academic hospital's geriatric MPU were invited to reflect on formulate the vision and mission of this ward. Twenty-two of them took part in the focus group interviews. The interviews focused on defining the MPU's functioning, its objectives, how it will reach these objectives, and where the MPU aspires to go. The interviews were transcribed verbatim and analyzed according to the QUAGOL guide. The themes from the analysis emerged from these group discussions. The participants defined the MPU's vision as to excel in integrated mental and physical geriatric inpatient healthcare, inspiring others to shed the stigma related to this vulnerable patient population. The mission that emerged from the focus group discussions is to provide patient-centered, integrated healthcare for older adults with combined mental and physical disorders. To achieve this, involving the patient's network, interdisciplinarity, shared decision-making, clear communication between all stakeholders, and reintegration of patients into their communities emerged as important themes. This study provides a vision and mission of a geriatric MPU in an academic psychiatric hospital. Since there is no consensus in the literature about the characteristics of MPUs despite the international call for integrated care for older persons with combined mental and physical disorders, these vision and mission statements can feed the discussion on how to install excellent healthcare for this vulnerable patient population.

The Impact of COVID-19 on Psychiatric Acuity in a Community Psychiatric Hospital

ABSTRACT

The COVID-19 pandemic has had extensive impacts on mental health care delivery. Anecdotal observations of inpatient care teams at Pennsylvania Psychiatric Institute suggested increased patient acuity during the pandemic. The authors found no consensus definition for measuring psychiatric acuity in the literature. We performed an interrupted time series analysis to identify whether COVID-19 was associated with changes in several hospital parameters that might reflect our patients' access to psychiatric services and acuity. We found increases in inpatient parameters for length of stay, rates of involuntary admissions, and the incidence of restraints, seclusion, and 1:1 observation orders. Observing these increasing trends can inform mitigation efforts to improve the quality of mental health care treatment and care delivery. We suggest the use of these metrics for objective measurements of psychiatric acuity.

[The Intensive Psychiatric Care Unit at a Hospital with Maximum Care - An Analysis of Treatment Variables in the Therapy of Psychiatric and comorbid Somatic Disorders]

ZIEL DER STUDIE UND METHODIK

Alle 873 Behandlungsakten einer psychiatrischen Intensivstation aus einem Zeitraum von 5 Jahren gingen in eine Analyse des Patientenkollektivs, des Behandlungsoutcomes und von Prädiktoren für die stationäre Behandlungsdauer ein.

ERGEBNISSE UND SCHLUSSFOLGERUNG

Auf der beschriebenen Station wurden sowohl Patienten mit psychiatrischen Notfallsyndromen als auch Patienten mit komorbiden psychischen und somatischen Erkrankungen behandelt. Somatische Zusatzerkrankungen beeinflussen den stationären Behandlungsverlauf psychisch Erkrankter erheblich, z. B. durch eine um durchschnittlich 2,4 Wochen kürzere intensivpsychiatrische stationäre Behandlungsdauer bei häufiger Notwendigkeit (41,3%) einer stationären, z. B. rehabilitativen Anschlussbehandlung. Die Stationsauslastung von 110 % und die durchschnittliche Behandlungsdauer von 63 Tagen deuten auf einen hohen Bedarf an interdisziplinären psychiatrisch-somatischen Behandlungsmöglichkeiten hin. In Zukunft ist ein Zusammenwachsen von Psychiatrie und somatischer Medizin anzustreben. Untersuchungen zu Versorgungssituation und Wirtschaftlichkeit interdisziplinärer Behandlungsangebote stehen aus.

BACKGROUND AND METHOD

All 873 medical files of psychiatric inpatients treated over a 5 year period at a psychiatric intensive care unit were analyzed in regard to characteristics of the patient group, outcome and predictors for the length of stay.

RESULTS AND CONCLUSIONS

Patients with psychiatric emergency syndromes and patients with comorbid psychiatric and somatic disorders were treated on the described unit. Somatic comorbidities have a considerable effect on the course of treatment for patients with psychiatric disorders. They have to receive stationary treatment for a shorter period (2.4 weeks) but often need further stationary, e. g. rehabilitative treatment. The utilization of this specific unit (110%) and the above average length of stay (63 days) point to an increasing need in inpatient treatment capacities for patients with psychiatric and somatic comorbidities. In future a growing together of somatic medicine and psychiatry in Germany is worthwhile. The evaluation of the treatment situation and aspects of cost effectiveness are yet to come.

Medical comorbid diagnoses among adult psychiatric inpatients

OBJECTIVE

Shortened life expectancy of people with mental disorders has been attributed to medical comorbidities, yet these conditions remain under-recognized and under-treated. This study characterizes the medical demands placed on inpatient psychiatric units to help guide medical assessment and management practices in these settings.

METHODS

Medicaid claims records and clinician data were linked with hospital and regional data for individuals with a principal diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. A modified Elixhauser Comorbidity Index (ECI) score was calculated for each unique individual (n = 14,458). Adjusted odds ratios (AORs) of having a medical comorbidity were calculated using logistic regression analyses.

RESULTS

74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24. Higher rates of medical comorbidity were associated with older age, female gender, non-schizophrenia diagnoses, and engagement in care prior to hospitalization. Patients with medical comorbidities had lower odds (AOR 0.54; 99% CI 0.35-0.83) of being treated in hospitals with 100 or more total beds compared to smaller hospitals.

CONCLUSIONS

A high prevalence of common medical diagnoses among psychiatric inpatients underscores the importance of adequate detection and medical treatment of medical comorbidities in psychiatric inpatient settings.