Acute Psychiatric Beds: Distribution and Staffing in NSW and ACT

1995 ◽  
Vol 29 (2) ◽  
pp. 238-247 ◽  
Author(s):  
Stephen Rosenman
Keyword(s):  
Admission Rate ◽  
Private Hospitals ◽  
Admission Rates ◽  
Acute Psychiatry ◽  
Department Of Health ◽  
Barriers To Access ◽  
Nursing Staffing ◽  
Psychiatric Beds ◽  
Occupancy Rates ◽  
Average Occupancy

This study examined the availability and staffing of acute psychiatry beds in NSW and ACT. “Gazetted” acute psychiatry hospitals (which take compulsory admissions under mental health law) were polled directly for bed numbers, occupancy and staffing for the year 1990–1991. The NSW Department of Health provided beds numbers for non-gazetted and private hospitals. Four analyses sequentially reallocated beds according to the origin of patients to estimate acute bed availability and use by regional populations. Socio-demographic determinants of acute admission rates were measured. Acute “gazetted” beds averaged 13.2 per 100,000 population but ranged from 6.9 to 49.1 per 100,000 when cross-regional flows were considered. “Non-gazetted” beds raised the provision to 15.5 per 100,000 and private beds raised provision further to 24.5 per 100,000. Inner metropolitan provision was higher than rural or provincial provision. The only determinant of the admission rate to gazetted beds was the number of available beds. Bed availability did not affect either bed occupancy or referral of patients to remote hospitals. Nursing staffing of gazetted units was reasonably uniform, although smaller units had significantly more nurses per bed. Medical staffing was highly variable and appears determined by staff availability. The average provision of acute psychiatric beds approximates lowest levels seen in international models for psychiatric services. Average occupancy rates suggest that there is not an overall shortfall of acute psychiatric beds, but uneven bed distribution creates barriers to access. Referral of patients to remote hospitals is not related to actual bed provision in the regions, but appears to reflect attitudes to ensuring local care. Recommendations about current de facto standards are made. Current average nursing and medical staffing standards are reported.

scholarly journals Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data

2021 ◽  
Vol 12 ◽  
Author(s):  
Adrian P. Mundt ◽  
Sabine Delhey Langerfeldt ◽  
Enzo Rozas Serri ◽  
Mathias Siebenförcher ◽  
Stefan Priebe
Keyword(s):  
Systematic Review ◽  
Community Care ◽  
Integration Of Care ◽  
Admission Rates ◽  
Expert Opinions ◽  
Psychiatric Beds ◽  
Occupancy Rates ◽  
Mental Health Policies ◽  
Bed Numbers

Introduction: Mental health policies have encouraged removals of psychiatric beds in many countries. It is under debate whether to continue those trends. We conducted a systematic review of expert arguments for trends of psychiatric bed numbers.Methods: We searched seven electronic databases and screened 15,479 papers to identify expert opinions, arguments and recommendations for trends of psychiatric bed numbers, published until December 2020. Data were synthesized using thematic analysis and classified into arguments to maintain or increase numbers and to reduce numbers.Results: One hundred six publications from 25 countries were included. The most common themes arguing for reductions of psychiatric bed numbers were inadequate use of inpatient care, better integration of care and better use of community care. Arguments to maintain or increase bed numbers included high demand of psychiatric beds, high occupancy rates, increasing admission rates, criminalization of mentally ill, lack of community care and inadequately short length of stay. Cost effectiveness and quality of care were used as arguments for increase or decrease.Conclusions: The expert arguments presented here may guide and focus future debate on the required psychiatric bed numbers. The recommendations may help policymakers to define targets for psychiatric bed numbers. Arguments need careful local evaluation, especially when supporting opposite directions of trends in different contexts.

scholarly journals Re-Admission Rates within 28 Days of Total Hip Replacement

2006 ◽  
Vol 88 (5) ◽  
pp. 475-478 ◽  
Author(s):  
C Cullen ◽  
DS Johnson ◽  
G Cook
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Admission Rate ◽  
Wound Complications ◽  
Superficial Infection ◽  
Total Hip ◽  
Admission Rates ◽  
Department Of Health ◽  
The Uk ◽  
Atraumatic Dislocation

INTRODUCTION The aim of the study was to identify the reasons for the higher than expected emergency re-admission to hospital within 28 days of total hip replacement (THR) for Stepping Hill Hospital, Stockport. PATIENTS AND METHODS Over a 42-month period, 65 (8.5%) of 769 patients were re-admitted within 28 days of discharge following primary THR. Case notes for 61 patients were available for retrospective review to assess premorbidity, initial postoperative complications and reason for re-admission. RESULTS The main reasons for re-admission were complications related to the procedure. These included thrombo-embolic disease 2.5%, atraumatic dislocation 1.4%, wound complications 1.2% and swollen limb 1.8%. Other causes such as admission to another department for problems not related to THR accounted for 0.8%. CONCLUSIONS Our findings are comparable with the published literature for early complications following THR. The three main reasons for re-admission were atraumatic dislocation, thrombo-embolic and wound complications such as superficial infection and haematoma are the commonest world-wide. The re-admission rate to hospital within the first 28 days following THR was a clinical indicator suggested by the UK Department of Health. It has subsequently been incorporated in a group of indicators used by the CASPE Healthcare Knowledge Systems (CHKS), a private healthcare consultancy and analysis company, for peer benchmarking. Our re-admission rates are inflated by admissions for non-THR-related reasons. The level of post-THR complications leading to re-admission were acceptable compared with the available published literature regarding 28-day re-admission. We anticipate that this study may act as a benchmark for other trusts.

scholarly journals Unplanned General Surgical Re-Admissions – How Many, Which Patients and Why?

2007 ◽  
Vol 89 (4) ◽  
pp. 363-367 ◽  
Author(s):  
Dayo Adeyemo ◽  
Simon Radley
Keyword(s):  
Postoperative Complications ◽  
Performance Indicator ◽  
Admission Rate ◽  
Index Admission ◽  
Admission Rates ◽  
Department Of Health ◽  
Retrospective Audit ◽  
Admission Data ◽  
The Uk ◽  
Patient Administration System

INTRODUCTION The unplanned re-admission rate is a national key performance indicator employed by the UK Department of Health. An adjusted figure, based on admission information data on the hospital electronic Patient Administration System (PAS), but adjusted to take account of case mix is compared with a calculated ‘expected’. While previous studies have investigated unplanned re-admission rates in age-, procedure- or process-specific conditions, ‘all-cause’ general surgical re-admission rate is yet to be studied. The aim of this study was to assess the accuracy of hospital unplanned re-admission data, and identify patterns or possible causes of unplanned general surgical re-admissions. PATIENTS AND METHODS Retrospective audit of case note records of all patients identified from the hospital electronic PAS as unplanned, general surgical re-admissions over a period of 4 consecutive months. RESULTS Of all 161 re-admissions in this study, 46 (29%) were unrelated to the index admission, planned or involved patient self-discharge during the index admission. Of the ‘genuine’, unplanned re-admissions, 80 (78%) followed an emergency index admission, 58 (56%) had chronic or recurrent symptoms, for which 26 (25%) were on waiting lists. Fourteen (14%) were multiple admissions of 4 patients, while 8 (8%) re-admissions required further surgery for significant postoperative complications. CONCLUSIONS Unplanned. general surgical re-admission rates collated from hospital PAS systems may be inaccurate. Nearly half of ‘genuine’, unplanned re-admissions involved patients with chronic and/or recurrent symptoms, which are predictable and may be preventable. Significant postoperative complications accounted for few re-admissions in this study.

scholarly journals 272 Morbid Obesity in Lower Limb Arthroplasty: Short Length of Stay and Favourable One-Year Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Sharrock ◽  
A Nugur ◽  
S Hossain
Keyword(s):  
Morbid Obesity ◽  
Length Of Stay ◽  
Lower Limb ◽  
Average Length ◽  
Perioperative Complications ◽  
Joint Infection ◽  
Admission Rate ◽  
Tendon Injury ◽  
Morbidly Obese ◽  
Admission Rates

Abstract Introduction There are concerns that BMI is associated with a greater length of stay (LOS) and perioperative complications in lower limb arthroplasty. Method We analysed data from a six-month period to see if there was a correlation between BMI and LOS. We performed a subgroup analysis for patients with morbid obesity (BMI >40). Results 285 TKRs and 195 THRs were analysed. For TKRs, the average length of stay was 2.7 days. There was no significant correlation between BMI and LOS (r=-0.0447, p = 0.2267). The morbidly obese category (n = 33) had the shortest LOS (2.5 days) compared to other BMI categories. 30-day readmission rate was 6%. 90-day re-admission rate was 12%. Six patients had minor wound issues requiring no intervention or antibiotics only. The was one prosthetic joint infection, one stitch abscess, one DVT and one patellar tendon injury. For THRs, the average LOS was 2.9 days. There was no significant correlation between BMI and LOS (r = 0.007, p = 0.4613). The morbid obese category (n = 9) had the shortest LOS (1.9 days) compared to other BMI categories. No patients were readmitted within 90 days or had documented complications. Conclusions Increased BMI is not associated with increased LOS. The morbidly obese had the shortest LOS, and commendable complication and re-admission rates.

THE IMPACT OF THE ROCHESTER NEIGHBORHOOD HEALTH CENTER ON HOSPITALIZATION OF CHILDREN, 1968 TO 1970

PEDIATRICS ◽  
1973 ◽  
Vol 51 (5) ◽  
pp. 833-839
Author(s):  
Michael Klein ◽  
Klaus Roghmann ◽  
Kenneth Woodward ◽  
Evan Charney
Keyword(s):  
Health Center ◽  
Comparison Group ◽  
Admission Rate ◽  
Team Approach ◽  
Target Area ◽  
Admission Rates ◽  
Respiratory Infectious Diseases ◽  
Physician Availability ◽  
Hospital Days ◽  
The Impact

The admission patterns of children to area hospitals was studied. The study design allowed for comparisons between actual users of the health center, nonusers who lived in the target area and a comparison group. During the second year of operation, the admission rate of health center users was only 33 versus 67 per thousand for nonusers and 39 per thousand for the comparison group. Comparing the first two years, hospital days per thousand among users dropped by approximately half. Due to higher admission rates and longer average stays, nonusers had a rate of 2.5 times that of the users for hospital days per thousand. The rate for the comparison group remained constant. Users had fewer admissions for respiratory infectious diseases and more admissions for surgical restorative procedures. These trends were not present for the nonusers or for the comparison group. Despite extensive outreach, physician availability, and the team approach, the health center continued to have a large number of child admissions who reached the hospital without referral (the "leakers").

scholarly journals MP008: Quick to be seen; quick to come back: does first visit CTAS-category predict admission for unplanned returns?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S68-S69
Author(s):  
D. Lewis ◽  
P.R. Atkinson ◽  
J. Fraser ◽  
M. Howlett
Keyword(s):  
Quality Indicator ◽  
Tertiary Care ◽  
Admission Rate ◽  
Care Hospital ◽  
Exact Test ◽  
Admission Rates ◽  
Triage Category ◽  
Important Quality ◽  
Return Visits ◽  
To Come

Introduction: The percentage of unplanned return visits (URV) to the Emergency Department (ED) within 48 or 72 hours of discharge that result in an admission to hospital has been recommended as the top Canadian ED patient safety quality indicator. International data exists although inconsistences exist in the way URV are defined and measured. To our knowledge there are no published Canadian data on the percentage of ED URV admissions. This study examines our own URV data and in particular the correlation between URV admission rates and first visit Canadian Triage Acuity Scale (CTAS) category. Methods: A retrospective analysis of 12-month’s data (January - December 2015) was completed for URV to the ED of a 445 bed regional tertiary care adult and pediatric teaching hospital with 57,000 annual attendances. URV was defined as any patient registering within 72 hours of an earlier visit that had resulted in a discharge from ED. Planned return visits were excluded. The data was analysed for an overall URV percentage, UV percentage by first visit CTAS category, overall percentage of URV admitted and URV admission percentage by first visit CTAS category. Pearson R correlation and Fishers Exact Test were used to test the relationship. Results: During the 12-month period there were 57,025 registrations of which 46,793 patients were discharged. There were 3566 URV (7.62% of those discharged); the number of URV admitted was 532 (1.14 % of those discharged). The return rate/admission rates by CTAS category were: CTAS 1: 6.74%/1.55%; CTAS 2: 7.86%/1.92%; CTAS 3: 8.54%/1.35%; CTAS 4: 5.99%/0.40%; CTAS 5: 5.55%/0.27%. The RR of admission on return for discharged CTAS groups 1 and 2, compared with CTAS 3, 4 and 5 was 1.90 (95 CI 1.57 to 2.30; p<0.0001). Rate of admission on return was negatively correlated with initial CTAS level (Pearson r = -0.89 (95 CI -0.99 to -0.03); R2=0.79; F=11.25; p=0.04). Conclusion: We have demonstrated a relationship between first visit CTAS category and the unplanned return admission rate. If admission is taken as a marker of illness severity, then the likelihood of an inappropriate discharge is inversely proportional to first visit CTAS score. While this makes sense intuitively, our data confirms this relationship in a Canadian tertiary care hospital and supports the reporting of ED URV admission data by first visit triage category as an important quality indicator.

scholarly journals 304 ED-FASU: A Novel ‘Front Door’ Multidisciplinary Service Assessing Patients with Falls and Syncope in the Emergency Department

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Robbie Bourke ◽  
Ciara Rice ◽  
Geraldine McMahon ◽  
Conal Cunningham ◽  
Rose Anne Kenny ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Geriatric Medicine ◽  
Admission Rate ◽  
Direct Access ◽  
Nurse Specialist ◽  
Similar Data ◽  
Ambulatory Care Setting ◽  
Specialist Registrar ◽  
Admission Rates

Abstract Background Patients with falls/syncope/presyncope frequently present to the emergency department (ED) and many that could be managed safely in an ambulatory care setting are admitted for extensive diagnostic work-up. A pilot intervention commenced in March 2019, with direct access to specialist assessment in the ED for patients presenting with falls/syncope/presyncope, aiming to provide appropriate testing and early diagnosis to reduce unnecessary hospitalizations. This pilot study assessed the feasibility of embedding this service within the ED, as well as the effectiveness of the intervention in terms of admission avoidance. Methods The study was conducted between 25th March and 19th April 2019 in a large urban teaching hospital with a dedicated Falls & Syncope Unit and compared to similar data from March/April 2018. The core ED-FASU team comprised a consultant geriatrician, specialist registrar in geriatric medicine and clinical nurse specialist. Inclusion criteria were those of all ages, presenting with falls/syncope/presyncope/dizziness between 0800-1800 Monday-Friday. Patients were reviewed directly from triage or after referral from the ED team. Results In total, 203 patients were assessed during the pilot, an average of 10 assessments per day. The median age of those seen was 63 (58.0-67.0) years. Almost one third (57/203) were aged ≥75 years. After excluding those who were already admitted to the acute hospital and awaiting a bed when seen in the ED (n=29), 24% (41/174) of those seen were admitted to hospital. This compares to an admission rate of 33% (73/223) for the 2018 comparison group (p = 0.045). Conclusion This pilot study shows that it is feasible to embed specialist assessment for falls/syncope/presyncope in the ED. Initial pilot data suggests a significant reduction in admission rates for those seen by this service but needs to be confirmed over a more prolonged assessment period and alongside data on readmission and length of stay.

scholarly journals Modelling out-of-area admissions

2018 ◽  
Vol 213 (4) ◽  
pp. 615-616 ◽  
Author(s):  
Lewis W. Paton ◽  
Paul A. Tiffin
Keyword(s):  
Mental Health ◽  
Community Services ◽  
Referral Rate ◽  
Referral Rates ◽  
Admission Rates ◽  
Department Of Health ◽  
Potential Impact ◽  
Using Data ◽  
Out Of Area ◽  
Health Trust

SummaryOut-of-area (OOA) placements occur when patients cannot be admitted to local facilities, which can be extremely stressful for patients and families. Thus, the Department of Health aims to eliminate the need for OOA admissions. Using data from a UK mental health trust we developed a ‘virtual mental health ward’ to evaluate the potential impact of referral rates and length of stay (LOS) on OOA rates. The results indicated OOA rates were equally sensitive to LOS and referral rate. This suggests that investment in community services that reduce both LOS and referral rates are required to meaningfully reduce OOA admission rates.Declaration of interestP.A.T. holds an honorary consultant contract with the Tees, Esk and Wear Valleys NHS Foundation Trust.

An Evaluation of Psychiatric After-care

1964 ◽  
Vol 110 (468) ◽  
pp. 662-667 ◽  
Author(s):  
Alan Sheldon
Keyword(s):  
Admission Rate ◽  
Community Mental Health Services ◽  
Revolving Door ◽  
Complex Nature ◽  
Admission Rates ◽  
After Care ◽  
Time In Treatment ◽  
Set Up ◽  
To Receive

Current planning in the field of the community mental health services places considerable emphasis on the after-care of patients discharged from hospital. This is partly in response to the high re-admission rates experienced as a result of the “revolving door” policy, partly to a scepticism about the present state of knowledge regarding factors amenable to primary prevention techniques, and partly to a belief that keeping the patient in the community is in itself beneficial both to the patient and to the community. The benefits of such a policy are felt to lie in avoidance of institutionalization and furthering of rehabilitation, and in preventing a re-distribution of roles within the family to exclude the patient. The primary purpose of the policy is not necessarily to cut short the illness of the patient, at least as measured by time under treatment, and evidence will be given below to suggest that in fact time in treatment is prolonged. This study focusses on one issue. Can aftercare in fact prevent re-admission to hospital to any significant extent? In view of the complex nature of the decision to select which patients are to receive after-care and which not, a factor in itself likely to prejudice any results, successive discharges from a psychiatric hospital falling within selected categories were randomly allocated to psychiatric after-care and to their general practitioner, and followed for a six-month period. A null hypothesis was set up that the re-admission rate during the follow-up period would not significantly differ in the two groups.

scholarly journals Low ninety-day re-admission rates after emergency and elective laparoscopic cholecystectomy in a district general hospital

2010 ◽  
Vol 92 (4) ◽  
pp. 307-310 ◽  
Author(s):  
Sue K Down ◽  
Marko Nicolic ◽  
Hibba Abdulkarim ◽  
Nick Skelton ◽  
Adrian H Harris ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Hospital ◽  
Admission Rate ◽  
Economic Cost ◽  
District General Hospital ◽  
Patient Characteristics ◽  
True Incidence ◽  
Admission Rates ◽  
Emergency Procedures ◽  
Elective Laparoscopic Cholecystectomy

INTRODUCTION Re-admission rate following laparoscopic cholecystectomy is currently defined as within 30 days of the initial operation. This may underestimate the true incidence and financial cost of postoperative morbidity. This study aimed to analyse re-admissions within 90 days of elective and emergency laparoscopic cholecystectomy at a district general hospital, and to compare outcomes to larger teaching centres. PATIENTS AND METHODS We undertook a retrospective analysis of all patients re-admitted within 90 days of laparoscopic cholecystectomy during an 18-month period (June 2006 to December 2007). Patient characteristics, details of the primary operation, and reasons for re-admission were identified, and a comparison of re-admissions following elective versus emergency procedures was performed. RESULTS A total of 326 laparoscopic cholecystectomies were performed during the 18-month period (246 elective, 80 emergency). No operations required conversion to an open procedure. Twenty-five patients were re-admitted within 90 days of their operation, of whom only 14 had complications directly related to their surgery (overall re-admission rate 4.3%). There was no statistical difference in re-admission rate or cause of re-admission between elective and emergency procedures. However, the mean time to re-admission following elective procedures was significantly longer (36 days; P = 0.0003). CONCLUSIONS Re-admission rates at our district general hospital are comparable to those reported by larger teaching centres. Current 30-day re-admission data may significantly underestimate morbidity rates and socio-economic cost following elective laparoscopic cholecystectomy.

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