The 23-Hour Observation Unit Admissions Within the Emergency Service at a National Tertiary Psychiatric Hospital: Clarifying Clinical Profiles, Outcomes, and Predictors of Subsequent Hospitalization

Objective:

We examined health care utilization, clinical profiles (such as sociodemographic features, clinical severity), and outcomes (inpatient admission, revisit within 24 hours of discharge) of patients who were admitted to a 23-hour observation unit within the emergency service of a tertiary psychiatric hospital and hypothesized that a specific clinical profile (greater clinical severity, lower psychosocial functioning) predicted subsequent inpatient hospitalization.

Method:

The medical records of all patients admitted to the observation unit from February 5, 2007, to February 4, 2012 (N = 2,158) were assessed for relevant data. Clinical severity and level of psychosocial functioning were assessed using Clinical Global Impressions–Severity (CGI-S) and Global Assessment of Functioning (GAF) scales, respectively.

Results:

Overall, the patients seen were predominantly Chinese males > 36 years old who had diagnoses including stress-related, anxiety, affective spectrum, and psychotic disorders. The clinical severity score (CGI-S) improved significantly following discharge from the observation unit (t_1,1848 = 23.316; P < .001). Logistic regression analyses revealed that self-referred (P = .001), older patients (P = .007) with past psychiatric history (P = .019), lower GAF scores (P = .025), and less improvement of CGI-S scores (P = .001) were associated with inpatient admission after a 23-hour stay in the observation unit.

Conclusions:

Our study findings affirmed our hypothesis and supported the utility of the observation unit in monitoring the overall clinical status of patients, which was linked with subsequent inpatient admissions. Better management of these patients at the outpatient level can potentially decrease unnecessary hospitalization and reduce health care cost as well as illness burden on patients and caregivers.

Clinical Points

• Health care utilization and clinical outcomes of patients admitted under brief hospitalization are scant.
• Self-referred, older patients with past psychiatric history, lower psychosocial functioning, and less improvement of clinical severity scores were more likely to have subsequent inpatient admission.
• Clinicians can potentially better manage patients under brief hospitalization to decrease unnecessary hospitalization, health care costs, and illness burden in patients and caregivers. 

Full article at:   http://goo.gl/w0vXhd

By:   Daw San San Thinn, MBBS, MMed, Carissa Nadia Kuswanto, MSc, Min Yi Sum, BA, Suet Bin Chai, MBBS, MMed, FAMS, Hian Koh Doris Sok, BHSc, Changqing Xu, MN, Alex Hsin Chuan Su, MBBS, MMed, Somnath Sengupta, MD,Rajesh Jacob, MD, and Kang Sim, MBBS, MMed, MScHPE, FAMS

Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum).

Corresponding author.

Corresponding author: Kang Sim, MBBS, MMed, MScHPE, FAMS, Department of General Psychiatry, Institute of Mental Health/Woodbridge Hospital, 10, Buangkok View, Singapore 539747 (Email: gs.moc.hmi@mis_gnak).

 

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