The effect of limited English proficiency and interpreter service use on clinical outcomes in psychiatric inpatient units

2019 ◽  
Vol 27 (5) ◽  
pp. 465-468
Author(s):  
Conor Daly ◽  
Karen Phillips ◽  
Richard Kanaan
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Limited English Proficiency ◽  
Service Use ◽  
English Proficiency ◽  
Psychiatric Inpatient ◽  
Psychiatric Units ◽  
Adult Inpatient ◽  
Interpreter Service ◽  
Inpatient Units

Objective: The effects of limited English and interpreter use on clinical outcomes in mental health are poorly understood. This paper describes an exploratory study examining those effects across three adult inpatient psychiatric units, predicting it would lead to increased length of stay. Methods: Forty-seven patients with limited English proficiency (LEP) were retrospectively identified and compared with 47 patients with proficient English. Length of stay, number of consultant reviews and discharge diagnosis were recorded and compared. Results: An increased length of stay for those with LEP was not statistically significant ( p=0.155). The LEP group did undergo more consultant reviews ( p=0.036), however, and attracted different discharge diagnoses, with no primary discharge diagnoses of personality disorder made ( p=0.018). Conclusions: This study provides evidence of significant effects of limited English on both service burden and outcome.

scholarly journals Reducing the use of high dose antipsychotic medication in acute adult inpatient psychiatric units

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S341-S341
Author(s):  
Shay-Anne Pantall ◽  
Sarah Warwicker ◽  
Lisa Brownell
Keyword(s):  
Antipsychotic Medication ◽  
Psychiatric Inpatient ◽  
Electronic Prescribing ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Junior Doctors ◽  
List Type ◽  
Increased Risk ◽  
Adult Inpatient ◽  
Inpatient Units

AimsTo evaluate the use of antipsychotics, and high dose antipsychotic treatment (HDAT) in psychiatric inpatient unitsBackgroundThe Royal College of Psychiatrists published a consensus statement on high dose antipsychotic medication in October 1993. Such treatment carries an increased risk of adverse effects including towards ventricular tachycardia and sudden death.MethodA retrospective case note review of all male patients on acute adult inpatient units in a psychiatric hospital in South Birmingham on a date in June 2018 (n = 45) including review of electronic patient records and prescriptions. This was compared with the results of an earlier study, with identical methods, undertaken in June 2015.Result•In both 2015 and 2018, only a minority of patients (20% and 11% respectively) were informal.•In both 2015 and 2018, the majority of inpatients had a diagnosis of schizophrenia (54% and 67%)•In both 2015 and 2018, 93% inpatients were prescribed antipsychotic medication.•In 2015, 56% patients were prescribed HDAT. This reduced in 2018 to 16%.•This reduction in use of HDAT was almost entirely due to a reduction in the prescription of PRN antipsychotic medication.•In terms of regularly prescribed antipsychotic medication, in both years, the most commonly prescribed drug was flupentixol, with a range of other second generation oral and long acting medications being prescribed, usually at doses within BNF limits.Between the two years, there was a substantial change in the prescribing of PRN antipsychotics. In 2015, 59% individuals were prescribed at least one PRN antipsychotic (27% were prescribed two). In 2018, this reduced to 40% prescribed at least one, and only 2% being prescribed 2 PRN antipsychotics. In both years, oral quetiapine was a common choice (39% patients in 2015 prescribed oral quetiapine, and 34% in 2018). In 2015, 39% patients were prescribed oral or intramuscular aripiprazole, while this reduced to 7% in 2018.ConclusionThe vast majority of psychiatric inpatients were being prescribed antipsychotic medication. Prescription of high dose antipsychotic medication was common in 2015, and this was largely attributable to high levels of prescribing of PRN antipsychotics. Following an educational programme for junior doctors and ward nurses, and the introduction of electronic prescribing, we achieved a significant change in practice, particularly in the prescribing of PRN antipsychotics, which has reduced our patients’ risk of receiving high dose antipsychotic medication.

scholarly journals Predictors of length of stay in psychiatric inpatient units: Does their effect vary across countries?

2018 ◽  
Vol 48 (1) ◽  
pp. 6-12 ◽  
Author(s):  
Giorgia Dimitri ◽  
Domenico Giacco ◽  
Michael Bauer ◽  
Victoria Jane Bird ◽  
Lauren Greenberg ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Psychiatric Inpatient ◽  
Patient Characteristics ◽  
Clinical Severity ◽  
Face To Face ◽  
History Of ◽  
The Given ◽  
Inpatient Units ◽  
Previous Admission ◽  
Complex Influence

AbstractBackgroundPrevious studies in individual countries have identified inconsistent predictors of length of stay (LoS) in psychiatric inpatient units. This may reflect methodological inconsistencies across studies or true differences of predictors. In this study we assessed predictors of LoS in five European countries and explored whether their effect varies across countries.MethodsProspective cohort study. All patients admitted over 14 months to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and United Kingdom were screened. Putative predictors were collected from medical records and in face-to-face interviews and tested for their association with LoS.ResultsAverage LoS varied from 17.9 days in Italy to 55.1 days in Belgium. In the overall sample being homeless, receiving benefits, social isolation, diagnosis of psychosis, greater symptom severity, substance use, history of previous admission and being involuntarily admitted predicted longer LoS. Several predictors showed significant interaction effects with countries in predicting LoS. One variable, homelessness, predicted a different LoS even in opposite directions, whilst for other predictors the direction of the association was the same, but the strength of the association with LoS varied across countries.ConclusionsThe same patient characteristics have a different impact on LoS in different contexts. Thus, although some predictor variables related to clinical severity and social dysfunction appear of generalisable relevance, national studies on LoS are required to understand the complex influence of different patient characteristics on clinical practice in the given contexts.

Length of Stay for Patients With Limited English Proficiency in Pediatric Urgent Care

2020 ◽  
Vol 59 (4-5) ◽  
pp. 421-428
Author(s):  
Aimy T. Patel ◽  
Brian R. Lee ◽  
Ravneet Donegan ◽  
Sharon G. Humiston
Keyword(s):  
Length Of Stay ◽  
Limited English Proficiency ◽  
Chart Review ◽  
English Proficiency ◽  
Retrospective Chart Review ◽  
Urgent Care ◽  
Starting Point ◽  
Significant Difference ◽  
English Speaking ◽  
Radiological Studies

This retrospective chart review compared the length of stay (LOS) of families with limited English proficiency (LEP) versus English-speaking families seen in 3 pediatric urgent care centers (PUCCs). Visits were included for patients aged 2 months to 17 years seen between January 1, 2016, and December 31, 2016, with 1 of 5 primary diagnoses. For each LEP encounter, we randomly selected 3 English-speaking encounters within the same PUCC and diagnosis class. We compared overall LOS between LEP and English-speaking encounters. Of our entire sample, 184 (1.03%) were LEP encounters, of which 145 (78.8%) preferred Spanish. Comparing the LEP visits to 552 matched English-speaking visits, we found a significant difference in average LOS (LEP 85.5 minutes; English-speaking 76.4 minutes) and in prescriptions provided ( P = .005) but not in triaged acuity nor number of medications administered, laboratory or radiological studies, or suction treatments. This study serves as a starting point to better care for patients/families with LEP in PUCCs.

scholarly journals A Canadian Medical-Psychiatric Inpatient Service*

1992 ◽  
Vol 37 (5) ◽  
pp. 326-334 ◽  
Author(s):  
J. Robert Swenson ◽  
François M. Mai
Keyword(s):  
Somatoform Disorders ◽  
Psychiatric Inpatient ◽  
The United States ◽  
Inpatient Service ◽  
Adequate Care ◽  
Psychiatric Inpatient Unit ◽  
Present Complex ◽  
Psychiatric Units ◽  
Adult Inpatient ◽  
One Year

Patients with both psychiatric and medical illnesses present complex and, at times, difficult diagnostic and management problems. Medical-psychiatric units designed to provide integrated medical and psychiatric care have been established in the United States. This paper describes the development and structure of such a unit established at a Canadian general hospital, using psychiatric facilities and resources already in place. A one year review of the characteristics of patients discharged from the service found that their mean length of stay was similar to that of inpatients discharged from the general adult inpatient services, but shorter than that of patients discharged from the psychogeriatric service. Many of these patients had neurological conditions; coexisting affective disorders, substance abuse, organic mental syndromes and somatoform disorders were diagnosed frequently. We believe that a medical-psychiatric inpatient unit can provide integrated care to patients who might otherwise receive less than adequate care.

scholarly journals Health professionals’ perceptions of how gender sensitive care is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carol O’Dwyer ◽  
Laura Tarzia ◽  
Sabin Fernbacher ◽  
Kelsey Hegarty
Keyword(s):  
Mental Health ◽  
Sexual Violence ◽  
Health Professionals ◽  
Psychiatric Inpatient ◽  
Models Of Care ◽  
Normalisation Process Theory ◽  
Biomedical Model ◽  
Case Study Methodology ◽  
Psychiatric Units ◽  
Inpatient Units

Abstract Background Sexual violence is a global public health issue. It is a form of gender-based violence commonly experienced by women accessing mental health services. The biomedical model has been the dominant model of care in acute psychiatric units, however, there has been a global movement towards more gender-sensitive and trauma-informed models. To date, only a small amount of research has focused on evaluating these models of care and health professionals’ experiences of providing this care. The aim of this study is to gain an in-depth understanding of healthcare professionals’ perceptions of how Gender Sensitive Care (GSC) is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence. Methods This study used case study methodology and the Normalisation Process Theory (NPT) conceptual framework. NPT is a practical framework that can be used to evaluate the implementation of complex models of care in health settings. It included semi-structured interviews with 40 health professionals, document and policy reviews, and observations from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic and content analysis. Results Themes were developed under the four NPT core constructs; 1) Understanding GSC in acute psychiatric units: “Without the corridors there’s not a lot we can do”, 2) Engagement and Commitment to GSC in acute psychiatric units: “There are a few of us who have that gender sensitive lens”, 3) Organising, relating and involvement in GSC: “It’s band aid stuff”, 4) Monitoring and Evaluation of GSC in acute psychiatric units: “We are not perfect, we have to receive that feedback”. Discussion Many health professionals held a simplistic understanding of GSC and avoided the responsibility of implementing it. Additionally, the competing demands of the biomedical model and a lack of appraisal has resulted in an inconsistent enactment of GSC. Conclusions Health professionals in this study enacted GSC to varying levels. Our findings suggest the need to address each NPT construct comprehensively to adequately implement GSC.

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