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Chen H, Devine M, Khan W, Khan IZ, Waldron R, Barry MK. The impact of psychiatric comorbidities on emergency general surgical patients' outcomes. Surgeon 2023; 21:289-294. [PMID: 36610867 DOI: 10.1016/j.surge.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Psychiatric disorders are increasingly prevalent. Studies have demonstrated that the presence of comorbid psychiatric conditions (CPC) is associated with a number of worsening outcomes in hospitalised patients in general. The relationship between a wide range of psychiatric comorbidities and acute surgical presentations has not been studied to date. STUDY DESIGN The Hospital In-Patient Enquiry (HIPE) system and prospectively maintained eHandover were used to identify all surgical emergency admissions to Mayo University Hospital, Ireland. Patient demographics, comorbidities, primary diagnoses, length of stay (LoS), and procedures undergone were recorded over a 12-months period. Subgroup analyses examining LoS variation in surgical presentation types were performed. RESULTS 1028 admissions occurred over this one year period, amongst 995 patients, the presence of psychiatric comorbidities increased the mean LoS by 1.9 days (p = 0.002). Comorbid depression, dementia, and intellectual disability conferred a significant increase in LoS by 2.4 days, 2.8 days and 6.7 days respectively. Subgroup analysis revealed greater LoS in patients with CPC diagnosed with non-specific abdominal pain (1.4 days, p = 0.019), skin and soft tissue infections (2.5 days, p = 0.040), bowel obstruction (4.3 days, p = 0.047), and medical disorders (18.6 days, p = 0.010). No significant difference was observed in mortality and readmission rates. CONCLUSION Psychiatric comorbidities significantly impact length of hospital stay and discharge planning in surgical inpatients. Greater awareness of this can facilitate better care delivery for this population to reduce the LoS and subsequent economic burden on the healthcare system.
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Affiliation(s)
- Hongying Chen
- Department of General Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland.
| | - Michael Devine
- Department of General Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland
| | - Waqar Khan
- Department of General Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland
| | - Iqbal Z Khan
- Department of General Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland
| | - Ronan Waldron
- Department of General Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland
| | - Michael K Barry
- Department of General Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland; Department of Breast Surgery, National University of Ireland Galway, Galway, Co. Galway, Ireland
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2
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Geier TJ, Simske N, Melin S, Trevino C, Murphy P, Schroeder ME, Brandolino A, deRoon-Cassini T, Schramm AT. Psychiatric comorbidity in emergency general surgery patients: a prospective observational study. Trauma Surg Acute Care Open 2023; 8:e001117. [PMID: 37622160 PMCID: PMC10445363 DOI: 10.1136/tsaco-2023-001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives Annually, approximately 27 million individuals in the United States are admitted to hospitals for emergency general surgery (EGS). Approximately 50% develop postoperative complications and 22% require unplanned readmission within 90 days, highlighting a need to understand factors impacting well-being and recovery. Psychiatric comorbidity can impact medical treatment adherence, cost, and premature mortality risk. Despite the severity of illness in EGS, there is limited research on psychiatric comorbidity in EGS patients. Thus, the purpose of the current study was to characterize EGS patient mental health and to assess its relationship with pain, social support, and healthcare utilization (ie, length of stay, readmission). Methods Adult EGS patients were screened for participation during hospitalization. Inclusion criteria included: (1) 18 years or older, (2) communicate fluently in English, and (3) assessed within 7 days of admission. Participants (n=95) completed assessment, which included a structured clinical diagnostic interview. Record review captured medical variables, including length of stay, discharge disposition, narcotic prescription, and 90-day readmission rates. Results Ninety-five patients completed the assessment, and 31.6% met criteria for at least one current psychiatric diagnosis; 21.3% with a major depressive episode, 9.6% with a substance use disorder, and 7.5% with post-traumatic stress disorder (PTSD). Lower perceived social support and greater pain severity and interference were significantly related to more severe depression and anxiety. Depression was associated with longer length of stay, and those with PTSD were more likely to be re-admitted. Conclusion The EGS patient sample exhibited psychiatric disorder rates greater than the general public, particularly regarding depression and anxiety. Screening protocols and incorporation of psychological and social interventions may assist in recovery following EGS. Level of evidence Level II, prognostic.
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Affiliation(s)
- Timothy J Geier
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Natasha Simske
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sarah Melin
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Colleen Trevino
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Patrick Murphy
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Amber Brandolino
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Terri deRoon-Cassini
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew T Schramm
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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3
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Ali H, Pamarthy R, Bolick NL, Lambert K, Naseer M. Relation between inflammatory bowel disease, depression, and inpatient outcomes in the United States. Proc AMIA Symp 2022; 35:278-283. [DOI: 10.1080/08998280.2022.2028344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Hassam Ali
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | - Rahul Pamarthy
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | | | - Karissa Lambert
- Department of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | - Maliha Naseer
- Department of Gastroenterology, Vanderbilt University, Nashville, Tennessee
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4
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Daray FM, Hunter F, Mullen MM. Health-related quality of life in hospitalized non-psychiatric medical patients: The impact of depressive symptoms. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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5
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Ratcliff CG, Massarweh NN, Sansgiry S, Dindo L, Cully JA. Impact of Psychiatric Diagnoses and Treatment on Postoperative Outcomes Among Patients Undergoing Surgery for Colorectal Cancer. Psychiatr Serv 2021; 72:391-398. [PMID: 33557593 DOI: 10.1176/appi.ps.201900559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychiatric diagnoses may be a risk factor for poor colorectal cancer (CRC) surgery outcomes. The authors investigated the risk of psychiatric diagnoses and benefit of mental health treatment for surgery outcomes among CRC patients. METHODS This retrospective cohort study of patients undergoing CRC surgery in the 2000-2014 period identified documentation of psychiatric diagnosis and mental health treatment (no treatment, medication only, psychotherapy only, or both medication and psychotherapy) 30 days before surgery. Associations between psychiatric diagnoses, mental health treatment, and postoperative outcomes (postoperative complications, length of stay [LOS], and 90-day readmission rate) were evaluated with multivariable generalized estimating equations. RESULTS Among 58,961 patients undergoing CRC surgery, 9,029 (15.3%) had psychiatric diagnoses, 4,601 (51.0%) of whom received preoperative mental health treatment (90.0% psychiatric medication, 6.7% psychotherapy, and 3.0% medication and psychotherapy). Patients with psychiatric diagnoses had an increased risk for postoperative complications (odds ratio [OR]=1.09, 95% confidence interval [CI]=1.03-1.15) and 90-day readmission (OR=1.11, 95% CI=1.06-1.17) compared with patients without psychiatric diagnoses. Patients with psychiatric diagnoses who received no mental health treatment or only medication had a 7%-17% increased risk for postoperative complications and 90-day readmission compared with patients without psychiatric diagnoses. Patients who received medication only also had a 4% increase in LOS relative to patients without psychiatric diagnoses. Patients with psychiatric diagnoses receiving only psychotherapy and patients without psychiatric diagnoses had similar postoperative outcomes. CONCLUSIONS Preoperative psychiatric diagnoses were associated with worse postoperative outcomes. Surgical quality-improvement efforts should focus on identifying patients with preoperative psychiatric diagnoses and addressing these conditions presurgery.
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Affiliation(s)
- Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully)
| | - Nader N Massarweh
- Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully)
| | - Shubhada Sansgiry
- Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully)
| | - Lilian Dindo
- Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully)
| | - Jeffrey A Cully
- Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully)
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6
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Mujic F, Cairns R, Das-Munshi J. Time of referral to older adult liaison psychiatry service and other factors affecting length of stay in the general hospital. Int J Geriatr Psychiatry 2021; 36:423-432. [PMID: 32976646 DOI: 10.1002/gps.5438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/16/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To explore the relationship between social and clinical factors with (1) Time to referral to an older adult liaison psychiatry service, and (2) Length of stay (LOS), in a sample of older adults admitted to an acute general medical hospital receiving liaison psychiatry intervention, in London, United Kingdom, over a 3-year period. METHODS Information on patients referred to liaison psychiatry for older adults between January 2013 and December 2015 was collected using structured forms, with clinical diagnoses determined according to International Classification of Mental Disorders-10. The association of social and clinical factors with the time taken to refer to liaison psychiatry and LOS was assessed using Cox proportional hazards regression and zero-truncated Poisson regression, respectively. RESULTS Compared with people who were diagnosed with depression, older adults with psychotic and alcohol use disorders had higher rates of referral to liaison psychiatry (adjusted hazard ratios [aHRs] 1.83 [95% CI: 1.30, 2.59] and aHR 1.69 [95% CI: 1.01, 2.83]) respectively. In adjusted models, LOS was increased in older adults with delusional disorders and shorter in people with alcohol use disorders, personality disorders and learning disabilities, compared to people with depressive diagnoses. Within this cohort, a new definite dementia diagnosis and longer time to refer to liaison psychiatry were both associated with a longer length of general hospital in-patient stay. CONCLUSIONS In older adults admitted to general medical hospitals, and needing liaison psychiatry input, timely referral may be associated with a shorter LOS.
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Affiliation(s)
- Fedza Mujic
- Department of Psychological Medicine, South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, King's College Hospital, London, UK
| | - Ruth Cairns
- Department of Psychological Medicine, South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, King's College Hospital, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, King's College Hospital, London, UK
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience (IoPPN), King's College London, London, UK
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7
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Beeler PE, Cheetham M, Held U, Battegay E. Depression is independently associated with increased length of stay and readmissions in multimorbid inpatients. Eur J Intern Med 2020; 73:59-66. [PMID: 31791574 DOI: 10.1016/j.ejim.2019.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the impact of depression across a broad range of multimorbid patients hospitalized for reasons other than depression. The objective of the study was to investigate in a large sample of multimorbid inpatients whether ancillary depression is associated with increased length of stay (LOS) and readmissions, two important clinical outcomes with implications for healthcare utilization and costs. METHODS We retrospectively analyzed a cohort of 253,009 multimorbid inpatients aged ≥18 at an academic medical center, 8/2009-8/2017. PRIMARY OUTCOME LOS. SECONDARY OUTCOMES LOS related to different main diagnoses, readmissions within 1, 3, 6, 12, and 24-months after discharge. RESULTS Multivariable linear regression showed 24% longer LOS in patients with ancillary depression (1.24; 95% confidence interval [CI]: 1.22, 1.25). Females stayed 22% longer (1.22; 95% CI: 1.20, 1.25), males 24% (1.24; 95% CI: 1.22, 1.27). We identified 16 main diagnosis clusters in which ancillary depression was associated with significant LOS increases, with associations being strongest for "Failure and rejection of transplanted organs and tissues", "Other noninfective gastroenteritis and colitis", and "Other soft tissue disorders, not elsewhere classified". Multivariable logistic and Poisson regression showed independent associations of ancillary depression with increased readmission odds and frequencies at 1, 3, 6, 12, and 24 months. CONCLUSIONS Ancillary depression was independently associated with increased LOS and more readmissions across a broad range of multimorbid inpatients.
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Affiliation(s)
- P E Beeler
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
| | - M Cheetham
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland.
| | - U Held
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
| | - E Battegay
- Department of Internal Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
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8
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The Impact of Integrated Psychiatric Care on Hospital Medicine Length of Stay: A Pre-Post Intervention Design With a Simultaneous Usual Care Comparison. PSYCHOSOMATICS 2019; 60:582-590. [DOI: 10.1016/j.psym.2019.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 11/17/2022]
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9
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Daray FM, Hunter F, Anastasia A, Fornaro M. Psychometric properties of the Patient Health Questionnaire nine-item version (PHQ-9) for use among hospitalized non-psychiatric medical patients. Gen Hosp Psychiatry 2019; 61:69-75. [PMID: 31715389 DOI: 10.1016/j.genhosppsych.2019.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 12/01/2022]
Affiliation(s)
- F M Daray
- Institute of Pharmacology, School of Medicine, University of Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Argentina.
| | - F Hunter
- José Ramos Mejia Hospital, Buenos Aires, Argentina
| | - A Anastasia
- National Institue for Social Security, Latina, Italy
| | - M Fornaro
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Dentistry, Naples, Italy
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10
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Aubert CE, Fankhauser N, Marques-Vidal P, Stirnemann J, Aujesky D, Limacher A, Donzé J. Multimorbidity and healthcare resource utilization in Switzerland: a multicentre cohort study. BMC Health Serv Res 2019; 19:708. [PMID: 31623664 PMCID: PMC6798375 DOI: 10.1186/s12913-019-4575-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 09/30/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Multimorbidity is associated with higher healthcare resource utilization, but we lack data on the association of specific combinations of comorbidities with healthcare resource utilization. We aimed to identify the combinations of comorbidities associated with high healthcare resource utilization among multimorbid medical inpatients. METHODS We performed a multicentre retrospective cohort study including 33,871 multimorbid (≥2 chronic diseases) medical inpatients discharged from three Swiss hospitals in 2010-2011. Healthcare resource utilization was measured as 30-day potentially avoidable readmission (PAR), prolonged length of stay (LOS) and difference in median LOS. We identified the combinations of chronic comorbidities associated with the highest healthcare resource utilization and quantified this association using regression techniques. RESULTS Three-fourths of the combinations with the strongest association with PAR included chronic kidney disease. Acute and unspecified renal failure combined with solid malignancy was most strongly associated with PAR (OR 2.64, 95%CI 1.79;3.90). Miscellaneous mental health disorders combined with mood disorders was the most strongly associated with LOS (difference in median LOS: 17 days) and prolonged LOS (OR 10.77, 95%CI 8.38;13.84). The number of chronic diseases was strongly associated with prolonged LOS (OR 9.07, 95%CI 8.04;10.24 for ≥10 chronic diseases), and to a lesser extent with PAR (OR 2.16, 95%CI 1.75;2.65 for ≥10 chronic diseases). CONCLUSIONS Multimorbidity appears to have a higher impact on LOS than on PAR. Combinations of comorbidities most strongly associated with healthcare utilization included kidney disorders for PAR, and mental health disorders for LOS.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. .,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | | | - Pedro Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jérôme Stirnemann
- Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | | | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.,Division of General Medicine, BWH Hospitalist Service, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Internal Medicine, Hôpital neuchâtelois, Neuchâtel, Switzerland
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11
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Jones A, Todman H, Husain M. Mental health in South East London general hospitals: using electronic patient records to explore associations between psychiatric diagnoses and length of stay in a patient cohort receiving liaison psychiatry input. BJPsych Open 2019; 5:e90. [PMID: 31608847 PMCID: PMC6854363 DOI: 10.1192/bjo.2019.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Psychiatric illnesses are prevalent in general hospitals and associated with length of stay (LOS). Liaison psychiatry teams provide psychiatric care in acute hospitals and can improve mental health-related outcomes but, to achieve ambitious policy targets, services must understand local need. AIMS Using electronic patient records, we investigate associations between psychiatric diagnoses and LOS in South East London hospitals. METHOD Patient records were extracted using the South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register Interactive Search system. There were 6378 admissions seen by liaison psychiatry aged <65 years between 2011 and 2016. Linear mixed-effects models investigated the impact of psychiatric diagnoses on LOS. Potential confounders included medical diagnoses, gender, age, ethnicity, social deprivation, hospital site and investment per admission. RESULTS According to marginal means, longer LOS is associated with primary diagnoses of organic disorders (mean: 23 days, 95% CI 20.39-25.61), depressive disorders (mean: 11.03 days, 95% CI 9.74-25.61) and psychotic disorders (mean: 10.63 days, 95% CI 8.75-12.51). Shorter LOS is associated with personality disorders (mean: 6.28 days, 95% CI 4.12-8.45), bipolar affective disorders (mean 6.81 days, 95% CI 3.49-10.14) and substance-related problems (mean 7.53 days, 95% CI 6.01-9.05). CONCLUSIONS Psychiatric diagnoses have differential associations with in-patient LOS. Liaison psychiatry teams aim to mitigate the impact of psychiatric illness on patient and hospital outcomes but understanding local need and the wider context of care provision is needed to maximise potential benefits. DECLARATION OF INTEREST M.H. is a consultant liaison psychiatrist for King's College Hospital adult liaison psychiatry team. At the time of writing, H.T. was senior business manager at SLaM psychological medicine and integrated care clinical academic group. These may be considered financial and/or non-financial interests given the implications of findings for service funding.
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Affiliation(s)
- Abbeygail Jones
- Research Assistant, South London and Maudsley NHS Foundation Trust, UK
| | - Helen Todman
- NHS Programme Manager, South London and Maudsley NHS Foundation Trust, UK
| | - Mujtaba Husain
- Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust, UK
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12
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Logan DE, Breazeal C, Goodwin MS, Jeong S, O'Connell B, Smith-Freedman D, Heathers J, Weinstock P. Social Robots for Hospitalized Children. Pediatrics 2019; 144:peds.2018-1511. [PMID: 31243158 DOI: 10.1542/peds.2018-1511] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Social robots (SRs) are increasingly present in medical and educational contexts, but their use in inpatient pediatric settings has not been demonstrated in studies. In this study, we aimed to (1) describe the introduction of SR technology into the pediatric inpatient setting through an innovative partnership among a pediatric teaching hospital, robotics development, and computational behavioral science laboratories and (2) present feasibility and acceptability data. METHODS Fifty-four children ages 3 to 10 years were randomly exposed to 1 of 3 interventions: (1) interactive SR teddy bear; (2) tablet-based avatar version of the bear; or (3) plush teddy bear with human presence. We monitored intervention enrollment and completion patterns, obtained qualitative feedback on acceptability of SR use from child life-specialist stakeholders, and assessed children's positive and negative affect, anxiety, and pain intensity pre- and postintervention. RESULTS The intervention was well received and appeared feasible, with 93% of those enrolled completing the study (with 80% complete parent data). Children exposed to the SR reported more positive affect relative to those who received a plush animal. SR interactions were characterized by greater levels of joyfulness and agreeableness than comparison interventions. Child life specialist stakeholders reported numerous potential benefits of SR technology in the pediatric setting. CONCLUSIONS The SR appears to be an engaging tool that may provide new ways to address the emotional needs of hospitalized children, potentially increasing access to emotionally targeted interventions. Rigorous development and validation of SR technology in pediatrics could ultimately lead to scalable and cost-effective tools to improve the patient care experience.
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Affiliation(s)
- Deirdre E Logan
- Departments of Anesthesia, Critical Care and Pain Medicine and.,Departments of Psychiatry and
| | - Cynthia Breazeal
- Media Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts; and
| | - Matthew S Goodwin
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Sooyeon Jeong
- Media Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts; and
| | - Brianna O'Connell
- Boston Children's Hospital Simulator Program and.,Child Life Services, Boston Children's Hospital, Boston, Massachusetts
| | | | - James Heathers
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Peter Weinstock
- Departments of Anesthesia, Critical Care and Pain Medicine and.,Boston Children's Hospital Simulator Program and.,Anesthesia, Harvard Medical School, Boston, Massachusetts
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13
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Bui M, Thom RP, Hurwitz S, Levy-Carrick NC, O'Reilly M, Wilensky D, Talmasov D, Blanchfield B, Vaidya V, Kakoza R, Klompas M, Stanley E, Gitlin D, Massaro A. Hospital Length of Stay With a Proactive Psychiatric Consultation Model in the Medical Intensive Care Unit: A Prospective Cohort Analysis. PSYCHOSOMATICS 2019; 60:263-270. [DOI: 10.1016/j.psym.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/17/2022]
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14
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Neff C, Totten C, Plymale M, Oyler DR, Davenport D, Roth JS. Associations between anxiolytic medications and ventral hernia repair. Hernia 2018; 22:753-757. [PMID: 29594842 DOI: 10.1007/s10029-018-1766-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/23/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examines the relationship between anxiolytic medications (AXM) on outcomes following ventral hernia repair. METHODS A single-center review of prospectively obtained perioperative and 30-day outcome data, including AXM use at admission, as part of the National Surgery Quality Improvement Program. RESULTS Sixty-three of the 393 patients who presented for ventral hernia repair were taking an AXM (15.6%). AXM users were more likely to have a higher ASA class, dyspnea, and treated hypertension (p < 0.05). AXM use was associated with increased operative duration, hernia size, increased estimated blood loss, and need for component separation. After adjusting for medical comorbidities, AXM users were not found to have greater 30-day morbidity or mortality. Patients taking AXM were found to have greater length of stay and increased hospital readmissions. CONCLUSIONS Patients taking anxiolytic medications undergoing ventral hernia repairs have higher ASA scores, more complex hernia characteristics, and require more concurrent procedures. They were found to have longer operative times, increased blood loss, greater duration of hospital stay, and increased readmissions that were associated with the increased perioperative risk factors. Further studies are required to determine causal links.
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Affiliation(s)
- C Neff
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - C Totten
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - M Plymale
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA.
| | - D R Oyler
- Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street, Lexington, KY, 40536, USA
| | - D Davenport
- Department of Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - J S Roth
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
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Jansen L, van Schijndel M, van Waarde J, van Busschbach J. Health-economic outcomes in hospital patients with medical-psychiatric comorbidity: A systematic review and meta-analysis. PLoS One 2018; 13:e0194029. [PMID: 29534097 PMCID: PMC5849295 DOI: 10.1371/journal.pone.0194029] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/23/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hospital inpatients often experience medical and psychiatric problems simultaneously. Although this implies a certain relationship between healthcare utilization and costs, this relationship has never been systematically reviewed. OBJECTIVE The objective is to examine the extent to which medical-psychiatric comorbidities relate to health-economic outcomes in general and in different subgroups. If the relationship is significant, this would give additional reasons to facilitate the search for targeted and effective treatments for this complex population. METHOD A systematic review in Embase, Medline, Psycinfo, Cochrane, Web of Science and Google Scholar was performed up to August 2016 and included cross-references from included studies. Only peer-reviewed empirical studies examining the impact of inpatient medical-psychiatric comorbidities on three health-economic outcomes (length of stay (LOS), medical costs and rehospitalizations) were included. Study design was not an exclusion criterion, there were no restrictions on publication dates and patients included had to be over 18 years. The examined populations consisted of inpatients with medical-psychiatric comorbidities and controls. The controls were inpatients without a comorbid medical or psychiatric disorder. Non-English studies were excluded. RESULTS From electronic literature databases, 3165 extracted articles were scrutinized on the basis of title and abstract. This resulted in a full-text review of 86 articles: 52 unique studies were included. The review showed that the presence of medical-psychiatric comorbidity was related to increased LOS, higher medical costs and more rehospitalizations. The meta-analysis revealed that patients with comorbid depression had an increased mean LOS of 4.38 days compared to patients without comorbidity (95% CI: 3.07 to 5.68, I2 = 31%). CONCLUSIONS Medical-psychiatric comorbidity is related to increased LOS, medical costs and rehospitalization; this is also shown for specific subgroups. This study had some limitations; namely, that the studies were very heterogenetic and, in some cases, of poor quality in terms of risk of bias. Nevertheless, the findings remain valid and justify the search for targeted and effective interventions for this complex population.
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Affiliation(s)
- Luc Jansen
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, Rotterdam, the Netherlands
- Zilveren Kruis Achmea, Department of Health Procurement, Leusden, the Netherlands
| | - Maarten van Schijndel
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, Rotterdam, the Netherlands
- Rijnstate Hospital, Department of Psychiatry, Arnhem, the Netherlands
| | - Jeroen van Waarde
- Rijnstate Hospital, Department of Psychiatry, Arnhem, the Netherlands
| | - Jan van Busschbach
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, Rotterdam, the Netherlands
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16
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Berg JE. Psychometric testing of immigrants and natives in an acute psychiatry facility. Ment Illn 2017; 9:6987. [PMID: 29383216 PMCID: PMC5768086 DOI: 10.4081/mi.2017.6987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- John E Berg
- Faculty of Health Sciences, Oslo and Akershus University Hospital, Oslo, Norway
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17
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Chinese non-psychiatric hospital doctors' attitudes toward management of psychological/psychiatric problems. BMC Health Serv Res 2017; 17:576. [PMID: 28830543 PMCID: PMC5568094 DOI: 10.1186/s12913-017-2521-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric comorbidities are common among patients treated for physical disorders. Attitudes of non-psychiatric doctors toward psychological/psychiatric problems have significant implications for care provision in the general hospital setting. Our objective was to investigate non-psychiatric doctors' attitudes in China. METHOD An anonymous online questionnaire pertaining to relevant attitudes was distributed to Chinese hospital-based non-psychiatric doctors using a mobile App. RESULTS A total of 306 non-psychiatric doctors in China voluntarily completed the questionnaire. All but two (99.3%) respondents agreed with the importance of psychological factors underlying physical illness and 85.6% agreed they had a high degree of responsibility for management of patients' emotional problems. Most respondents endorsed routine assessment of patients' psychological factors and were willing to consider psychiatric referrals for patients in need; despite 52.0% believing that mental health care by general hospital doctors was impractical. Almost all respondents welcomed more contact with psychiatric services and indicated a need for more time and professional help to manage psychological issues. Respondents' demographic characteristics and vocational status had some influence on attitudes; female doctors were more likely and surgeons less likely to consider psychological assessment and emotional care for patients with physical illness. More doctors working in hospitals with established consultation-liaison psychiatric services did not feel responsible for their patients' emotional care (17.7% vs. 6.6%, P = 0.012). CONCLUSIONS Our pilot survey demonstrates a potential generally positive attitude toward management of patients' psychological problems and an urgent need for more time and specialist support for non-psychiatric doctors in China.
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Yoshida S, Matsushima M, Wakabayashi H, Mutai R, Murayama S, Hayashi T, Ichikawa H, Nakano Y, Watanabe T, Fujinuma Y. Validity and reliability of the Patient Centred Assessment Method for patient complexity and relationship with hospital length of stay: a prospective cohort study. BMJ Open 2017; 7:e016175. [PMID: 28490567 PMCID: PMC5623372 DOI: 10.1136/bmjopen-2017-016175] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Several instruments for evaluating patient complexity have been developed from a biopsychosocial perspective. Although relationships between the results obtained by these instruments and the length of stay in hospital have been examined, many instruments are complicated and not easy to use. The Patient Centred Assessment Method (PCAM) is a candidate for practical use. This study aimed to test the validity and reliability of the PCAM and examine the correlations between length of hospital stay and PCAM scores in a regional secondary care hospital in Japan. DESIGN Prospective cohort study. PARTICIPANTS AND SETTING Two hundred and one patients admitted to Ouji Coop Hospital between July 2014 and September 2014. MAIN PREDICTOR PCAM total score in initial phase of hospital admission. MAIN OUTCOME Length of stay in hospital. RESULTS Among 201 patients (Female/Male=98/103) with mean (SD) age of 77.4±11.9 years, the mean PCAM score was 25±7.3 and mean (SD) length of stay in hospital (LOS) 34.1±40.9 days. Using exploratory factor analysis to examine construct validity, PCAM evidently has a two-factor structure, comprising medicine-oriented and patient-oriented complexity. The Spearman rank correlation coefficient for evaluating criterion-based validity between PCAM and INTERMED was 0.90. For reliability, Cronbach's alpha was 0.85. According to negative binomial regression analyses, PCAM scores are a statistically significant predictor (p<0.001) of LOS after adjusting for age, gender, Mini Nutritional Assessment Short-Form, Charlson Comorbidity Index, serum sodium concentration, total number of medications and whether public assistance was required. In another model, each factor in PCAM was independently correlated with length of stay in hospital after adjustment (medicine-oriented complexity: p=0.001, patient-oriented complexity: p=0.014). CONCLUSION PCAM is a reliable and valid measurement of patient complexity and PCAM scores have a significant correlation with hospital length of stay.
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Affiliation(s)
- Shuhei Yoshida
- Kitaadachi-seikyo Clinic, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
- Division of Clinical Epidemiology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center, Yokohama, Japan
| | - Rieko Mutai
- Division of Clinical Epidemiology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan
| | - Shinichi Murayama
- Division of Clinical Epidemiology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan
- Shioiri-seikyo clinic, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Tetsuro Hayashi
- Division of Clinical Epidemiology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hiroko Ichikawa
- Division of Clinical Epidemiology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan
- Tokyo Rinkai Byoin, Edogawa-ku, Tokyo, Japan
| | - Yuko Nakano
- Division of Clinical Epidemiology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan
- Japan Small Animal Cancer Center, Saitama, Japan
| | - Takamasa Watanabe
- Kitaadachi-seikyo Clinic, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
- Division of Clinical Epidemiology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
- Seikyo-ukima clinic, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
- Interprofessional Education Research Center (IPERC), Graduate School of Nursing, Chiba University, Chiba, Japan
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Poli R, Carreca A, Colmegna F, Ferraris S, Gagliardi E, Tamborini S, Toscano M. The practice of consultation psychiatry in Italy: A multi-centre study. J Psychosom Res 2017; 96:32-34. [PMID: 28545790 DOI: 10.1016/j.jpsychores.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 10/20/2022]
Affiliation(s)
- R Poli
- ASST Cremona DSM Cremona, via Largo Priori n.1, Cremona, Italy.
| | - A Carreca
- UOC Mental Health, 7 ASP Palermo, Italy
| | - F Colmegna
- Department of Mental Health ASST, Monza, Italy
| | | | - E Gagliardi
- Department of Mental Health ASST, Cremona, Italy
| | - S Tamborini
- Department of Mental Health ASST, Cremona, Italy
| | - M Toscano
- Department of Mental Health ASST, Cremona, Italy; Department of Mental Health ASST, Rhodense, Italy
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20
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Chen KY, Evans R, Larkins S. Why are hospital doctors not referring to Consultation-Liaison Psychiatry? - a systemic review. BMC Psychiatry 2016; 16:390. [PMID: 27829386 PMCID: PMC5103418 DOI: 10.1186/s12888-016-1100-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/28/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Consultation-Liaison Psychiatry (CLP) is a subspecialty of psychiatry that provides care to inpatients under non-psychiatric care. Despite evidence of benefits of CLP for inpatients with psychiatric comorbidities, referral rates from hospital doctors remain low. This review aims to understand barriers to CLP inpatient referral as described in the literature. METHODS We searched on Medline, PsychINFO, CINAHL and SCOPUS, using MESH and the following keywords: 1) Consultation-Liaison Psychiatry, Consultation Liaison Psychiatry, Consultation Psychiatry, Liaison Psychiatry, Hospital Psychiatry, Psychosomatic Medicine, the 2) Referral, Consultation, Consultancy and 3) Inpatient, Hospitalized patient, Hospitalized patient. We considered papers published between 1 Jan 1965 and 30 Sep 2015 and all articles written in English that contribute to understanding of barriers to CLP referral were included. RESULTS Thirty-five eligible articles were found and they were grouped thematically into three categories: (1) Systemic factors; (2) Referrer factors; (3) Patient factors. Systemic factors that improves referrals include a dedicated CLP service, active CLP consultant and collaborative screening of patients. Referrer factors that increases referrals include doctors of internal medicine specialty and comfortable with CLP. Patients more likely to be referred tend to be young, has psychiatric history, live in an urban setting or has functional psychosis. CONCLUSION This is the first systematic review that examines factors that influence CLP inpatient referrals. Although there is research in this area, it is of limited quality. Education could be provided to hospital doctors to better recognise mental illness. Collaborative screening of vulnerable groups could prevent inpatients from missing out on psychiatric care. CLP clinicians should use the knowledge gained in this review to provide quality engagement with referrers.
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Affiliation(s)
- Kai Yang Chen
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia. .,Townsville Hospital and Health Service, 100 Angus Smith Drive, Townsville, QLD 4814, Australia.
| | - Rebecca Evans
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
| | - Sarah Larkins
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
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21
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Anderson C, Tauch D, Quante A. Diagnosis and Treatment Procedures for Patients With Anxiety Disorders by the Psychiatric Consultation Liaison Service in a General Hospital in Germany: A Retrospective Analysis. Prim Care Companion CNS Disord 2016; 17:15m01805. [PMID: 26835174 DOI: 10.4088/pcc.15m01805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To investigate the population of patients with anxiety disorders in a general hospital in Germany who required treatment by a consultation psychiatrist. METHOD A retrospective investigation of psychiatric consultations concerning 119 patients with anxiety disorders (DSM-IV criteria) from January 1, 2011, to December 31, 2012, was conducted in a general hospital of the Charité Berlin, Berlin, Germany. The frequency of different anxiety disorders, the distribution of anxiety disorders among the departments of the general hospital, and the recommended treatment procedure were investigated. RESULTS The largest group of patients with anxiety symptoms presented panic attacks. Many of these patients sought treatment in the emergency department of the hospital primarily due to their anxiety symptoms. Within the group of somatically ill patients, panic attacks were prominent, especially in patients with cardiac or respiratory diseases. Treatment procedures comprised pharmacologic and psychotherapeutic interventions. Benzodiazepines and psychoeducation were common acute treatments; antidepressants, pregabalin, and psychotherapy were recommended for long-term treatment. CONCLUSIONS Many patients who primarily suffer from symptoms of anxiety seek treatment in a general hospital, especially in the emergency department. It is therefore very important for the individual patient as well as the health care system that the correct treatment is initiated. The consultation-liaison psychiatric service within a general hospital is important to ensure the best possible diagnostic procedures as well as treatment for patients with anxiety disorders.
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Affiliation(s)
- Christina Anderson
- Department of Psychiatry and Psychotherapy, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Deborah Tauch
- Department of Psychiatry and Psychotherapy, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Arnim Quante
- Department of Psychiatry and Psychotherapy, Charité-Campus Benjamin Franklin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh Hospital, Berlin, Germany
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22
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Wood R, Wand APF, Hunt GE. Relationship between timeliness of contact and length of stay in older and younger patients of a consultation-liaison psychiatry service. BJPsych Bull 2015; 39:128-33. [PMID: 26191451 PMCID: PMC4478928 DOI: 10.1192/pb.bp.114.047340] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 04/18/2014] [Accepted: 05/13/2014] [Indexed: 12/03/2022] Open
Abstract
Aim and methods The aims were to determine whether the timeliness of contact with a consultation-liaison psychiatry (CLP) service is associated with shorter lengths of stay (LOS), whether this relationship persists for stays greater than 4 days and whether this association varies with age. The length of stay was correlated with the time from admission to contact with the service (the referral lag (REFLAG)), and the REFLAG's proportion of length of stay (REFLAG/LOS) for all 140 in-patients, those with stays greater than 4 days, and for those under and over 65 years. Results The length of stay was significantly correlated with referral lag and logREFLAG/logLOS for all patients and for patients with stays greater than 4 days. The correlations remained significant for both age groups, but were stronger in the younger group. Clinical implications Timeliness of contact with CLP was associated with shorter length of stay, particularly in younger patients. Psychiatric factors influencing length of stay in older patients should be studied by CLP services.
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Affiliation(s)
- Rebecca Wood
- Sydney Local Health District ; Sydney Medical School, University of Sydney
| | - Anne P F Wand
- Sydney Medical School, University of Sydney ; South Eastern Sydney Local Health District ; University of New South Wales, Australia
| | - Glenn E Hunt
- Sydney Local Health District ; Sydney Medical School, University of Sydney
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Bujoreanu S, White MT, Gerber B, Ibeziako P. Effect of timing of psychiatry consultation on length of pediatric hospitalization and hospital charges. Hosp Pediatr 2015; 5:269-275. [PMID: 25934811 DOI: 10.1542/hpeds.2014-0079] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of timing of a psychiatry consultation during pediatric hospitalization on length of hospital stay and total hospitalization charges. METHODS The charts of 279 pediatric patients (totaling 308 consultations) referred to the psychiatry consultation liaison service at a freestanding tertiary pediatric hospital between January 1, 2010, and June 30, 2010 were retrospectively analyzed. The variables analyzed included the following: patient demographic characteristics; dates of admission, psychiatric consultation, and discharge; psychiatric diagnoses based on the psychiatric diagnostic evaluation; psychiatric treatment disposition; and illness severity and total charges associated with the medical stay. RESULTS Earlier psychiatry consultation was associated with shorter length of stay and lower hospitalization charges after adjusting for psychiatric functioning, physical illness severity, and psychiatric disposition. Poorer psychiatric functioning and milder physical illness were associated with shorter referral time. CONCLUSIONS Timely involvement of psychiatry consultation services during a medical or surgical hospitalization was associated with reductions in length of stay and total hospital charges in pediatric settings. These findings have important effects on quality of care via decreasing burden on the patient and family and on the medical system resources. Educating pediatric health care providers about the importance of early psychiatry consultation regardless of physical illness severity or psychiatric acuity will likely improve resource management for patients and hospitals.
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Affiliation(s)
- Simona Bujoreanu
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and
| | - Matthew T White
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and
| | - Bradley Gerber
- Department of Psychology, Austin State Hospital, Austin, Texas
| | - Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and
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Freidl M, Benda N, Friedrich F. Psychiatric illness and length of stay in general hospitals: do case finding methods matter? NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2015; 29:77-83. [PMID: 25917540 DOI: 10.1007/s40211-015-0144-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/17/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several prior studies have investigated whether patients with "non-cognitive" mental disorders (i.e., organic disorders, substance abuse, delirium, and psychotic disorders excluded) have longer Length Of Stay (LOS) than mentally healthy individuals in nonpsychiatric hospital settings. These studies yielded contrasting results. The present paper aims to examine whether methods of psychiatric case finding can explain these differences. METHODS Using the Clinical Interview Schedule (CIS) and the General Health Questionnaire (GHQ), 462 in-patients of medical, surgical, gynecological, and rehabilitation departments were assessed for the presence of psychiatric disorders. RESULTS In multiple regression analysis, all CIS-cases together did not show an association with LOS. Of the diagnostic groups assessed by CIS only major depression showed a significantly prolonged LOS. Using the GHQ sum-score as a continuous variable, LOS was significantly increased while using the GHQ as a dichotomous variable did not show such an association. After removing those suffering from multiple psychiatric diagnoses (such as major depression co-morbid with organic mental illness), none of the case definitions showed a significant association with LOS. CONCLUSIONS It seems that different case finding methods yield different results concerning the association of psychiatric disorders with LOS. When interpreting these results the small size of some subsamples must be taken into consideration.
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Affiliation(s)
- Marion Freidl
- Klinische Abteilung für Sozialpsychiatrie, Univ.-Klinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria,
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Teo V, Toh MR, Kwan YH, Raaj S, Tan SYD, Tan JZY. Association between Total Daily Doses with duration of hospitalization among readmitted patients in a multi-ethnic Asian population. Saudi Pharm J 2015; 23:388-96. [PMID: 27134540 PMCID: PMC4834684 DOI: 10.1016/j.jsps.2015.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/01/2015] [Indexed: 11/29/2022] Open
Abstract
Increased length of stay (LOS) in the hospital incurs substantial financial costs on the healthcare system. Multiple factors are associated with LOS. However, few studies have been done to associate the impact of Total Daily Doses (TDD) and LOS. Hence, the aim of this study is to examine the association between patients’ LOS upon readmission and their TDD before readmission. A retrospective cross-sectional study of readmission cases occurring from 1st January to 31st March 2013 was conducted at a regional hospital. Demographics and clinical variables were collected using electronic medical databases. Univariable and multiple linear regressions were used. Confounders such as comorbidities and drug related problems (DRP) were controlled for in this study. There were 432 patients and 649 readmissions examined. The average TDD and LOS were 18.04 ± 8.16 and 7.63 days ± 7.08 respectively. In the univariable analysis, variables that were significantly associated with the LOS included age above 75 year-old, race, comorbidity, number of comorbidities, number of medications, TDD and thrombocytopenia as DRPs. In the multiple linear regression, there was a statistically significant association between TDD (β = 0.0733, p = 0.030) and LOS. Variables that were found significant were age above 75 year-old (β = 1.5477, p = 0.008), Malay (β = −1.5123, p = 0.033), other races (β = −2.6174, p = 0.007), depression (β = 2.1551, p = 0.031) and thrombocytopenia as a type of DRP (β = 7.5548, p = 0.027). When TDD was replaced with number of medications, number of medications (β = 0.1487, p = 0.021), age of 75 year-old (β = 1.5303, p = 0.009), Malay (β = −1.4687, p = 0.038), race of others (β = −2.6499, p = 0.007), depression (β = 2.1951, p = 0.028) and thrombocytopenia as a type of DRP (β = 7.5260, p = 0.028) were significant. In conclusion, a significant relationship between TDD and number of medications before readmission and the LOS upon readmission was established. This finding highlights the importance of optimizing patients’ TDD in the attempt of reducing their LOS.
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Affiliation(s)
- Vivien Teo
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore
| | - Ming Ren Toh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore
| | - Yu Heng Kwan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore; Centre of Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Republic of Singapore; Department of Pharmacy, Khoo Teck Puat Hospital, Republic of Singapore
| | - Sreemanee Raaj
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore
| | - Su-Yin Doreen Tan
- Department of Pharmacy, Khoo Teck Puat Hospital, Republic of Singapore
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Sugawara N, Metoki N, Hagii J, Saito S, Shiroto H, Tomita T, Yasujima M, Okumura K, Yasui-Furukori N. Effect of depressive symptoms on the length of hospital stay among patients hospitalized for acute stroke in Japan. Neuropsychiatr Dis Treat 2015; 11:2551-6. [PMID: 26491334 PMCID: PMC4599635 DOI: 10.2147/ndt.s91303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression after stroke is one of the most serious complications of stroke. Although many studies have shown that the length of hospital stay (LOHS) is a measurable and important stroke outcome, research has found limited evidence concerning the effect of depression on LOHS among patients who have experienced acute stroke. The objective of this study was to assess the effect of depression on LOHS among patients hospitalized for acute ischemic stroke in Japan. METHODS We retrospectively examined 421 patients who had experienced acute ischemic stroke. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS) on the 7th day of hospitalization. On the 10th day of hospitalization, depressive symptoms and functional assessment were assessed by the Japan Stroke Scale (Depression Scale) and the Functional Independence Measure, respectively. A general linear model was employed to assess the effect of probable depression on LOHS. RESULTS The prevalence of probable depression in the current sample was 16.3% in males and 17.8% in females. The mean LOHS of participants with probable depression (76.4±49.2 days) was significantly longer than that of participants without probable depression (44.9±39.2 days). An analysis using the general linear model to assess the effect on LOHS revealed a significant interaction between the presence of probable depression and NIHSS scores. CONCLUSION Depression after stroke was associated with significant increases in LOHS. Early detection and treatment for depression are necessary for patients with ischemic stroke.
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Affiliation(s)
- Norio Sugawara
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | | | - Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Shin Saito
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | | | - Tetsu Tomita
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
| | | | - Ken Okumura
- Department of Cardiology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan
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Maeda T, Babazono A, Nishi T, Tamaki K. Influence of psychiatric disorders on surgical outcomes and care resource use in Japan. Gen Hosp Psychiatry 2014; 36:523-7. [PMID: 24973124 DOI: 10.1016/j.genhosppsych.2014.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the effects of psychiatric disorders on major surgery outcomes and care resource use. METHODS This study adopted a retrospective cohort study design. The samples consisted of hospital stays. Subjects were patients who had undergone major surgery. We used multilevel regression analysis to quantify the influence of psychiatric disorders on major surgery outcomes and care resource use. RESULTS The total number of hospital stays included in the study was 5569, of which 250 were patients with psychiatric disorders. Compared with those without psychiatric disorders, those with schizophrenia had a significantly higher risk of complications, and those with neurotic disorder tended to have fewer complications. Total cost was significantly higher for those with schizophrenia and mood disorder and significantly lower in those with neurotic disorder. Lengths of stay were significantly longer for those with schizophrenia and mood disorder but not for those with neurotic disorder. Post-surgical mortality was equivalent among those with any psychiatric disorder and among those without a psychiatric disorder. CONCLUSION The study revealed that surgical outcomes and care resource use are differentiated by psychiatric disorders.
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Affiliation(s)
- Toshiki Maeda
- Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, Fukuoka 812-8581, Japan.
| | - Akira Babazono
- Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, Fukuoka 812-8581, Japan.
| | - Takumi Nishi
- Department of Healthcare Administration and Management, Graduate School of Healthcare Sciences, Kyushu University, Fukuoka 812-8581, Japan.
| | - Kazumitsu Tamaki
- Division of Internal Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa 904-2293, Japan.
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Rukundo ZG, Musisi S, Nakasujja N. Psychiatric morbidity among physically ill patients in a Ugandan Regional Referral Hospital. Afr Health Sci 2013; 13:87-93. [PMID: 23658573 PMCID: PMC3645103 DOI: 10.4314/ahs.v13i1.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mental illness is a global health burden that remains poorly understood even by health care providers. It is important to get insight of the prevalence, clinical features and management of psychiatric morbidity in general practice in Uganda as it affects treatment outcome. OBJECTIVE To determine the prevalence, types and associations of psychiatric morbidity as seen among adult in-patients on medical and surgical wards of Mbarara Regional Referral hospital as a prototype Ugandan regional referral hospital. METHODS This was a cross sectional descriptive study. Psychiatric diagnosis was arrived at by administering the Mini International Neuropsychiatric Interview (MINI) as the diagnostic instrument. RESULTS Of the 258 participants in this study, 109 (42%) met criteria for at least one DSM IV psychiatric diagnosis. Only 6% of all the psychiatrically diagnosed patients were recognized by their treating doctors as having mental illness. CONCLUSION The psychiatric disorders on the general medical and surgical wards are highly prevalent and not recognized by staff on these wards despite their common occurrence. There is need for sensitisation of staff on recognition and management of psychiatric disorders in physical illness.
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Affiliation(s)
- Z G Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
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Zyoud SH, Awang R, Sulaiman SAS, Al-Jabi SW. An analysis of the length of hospital stay after acetaminophen overdose. Hum Exp Toxicol 2011; 30:550-9. [PMID: 20630911 DOI: 10.1177/0960327110377647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Acetaminophen is one of the most commonly encountered medications in self-poisoning, with a high rate of morbidity. The prevalence and characteristics of acetaminophen intoxication associated with long hospital stay in patients are not well defined. OBJECTIVES This study aims to identify the clinical and demographic factors associated with the length of in-hospital stay (LOS), and to evaluate the effect of early treatment of acetaminophen overdose patients (≤8 hours) by intravenous N-acetylcysteine (IV-NAC) on hospital stay. METHODS This is a retrospective cohort study of hospital admissions for acetaminophen overdose conducted over a period of 5 years from 1 January 2004 to 31 December 2008. Patients were divided into two groups: LS group patients had a long hospital stay (> median hours stay in hospital) and SS group patients had a short hospital stay (≤ median hours stay in hospital). Variables were abstracted from medical records for comparison between the two groups. A total of 20 variables were identified for comparison. Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. SPSS 15 was used for data analysis. RESULTS Of the 305 patients, 11 factors were identified in the univariate analysis as associated with LS. Three independent factors were found to be significant predictors of LS in the multivariate analysis. The factors associated with LS were seen among patients with a history of abdominal pain after ingestion of acetaminophen (p = 0.04), who were on IV-NAC administration (p < 0.001) and had an acutely depressed mood (p = 0.003). Late time to NAC infusion of more than 8 hours was associated with LS rather than SS (96 patients [57%] and 6 [24%], respectively; p = 0.003). CONCLUSION Patients with long hospital stay have different clinical characteristics compared to patients with short hospital stay. We identified time to IV-NAC administration is a potentially modifiable factor that may lead to prolonged hospital stay. When risk assessment indicates that NAC is required, it is highly recommended that NAC be started in the first hours of admission to reduce the LOS.
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Affiliation(s)
- Sa'ed H Zyoud
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia, Penang, Malaysia.
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Hochlehnert A, Niehoff D, Wild B, Jünger J, Herzog W, Löwe B. Psychiatric comorbidity in cardiovascular inpatients: costs, net gain, and length of hospitalization. J Psychosom Res 2011; 70:135-9. [PMID: 21262415 DOI: 10.1016/j.jpsychores.2010.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 09/14/2010] [Accepted: 09/28/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although psychiatric comorbidity often goes undetected and untreated in cardiovascular patients, it is not clear whether the costs for a special treatment of psychiatric comorbidity are appropriately reflected in the reimbursement system. To investigate the economic impact of psychiatric comorbidity, we compared costs, returns, net gain, and duration of hospitalization in cardiovascular inpatients with and without psychiatric comorbidity. METHODS For a period of 2 years, we analyzed costs, net gain, and other outcome variables according to the diagnosis-related group (DRG) system for cardiovascular inpatients of a German university department (n = 940). Psychiatric disorders were diagnosed by the treating physicians based on clinical criteria and results from the Patient Health Questionnaire (PHQ). With respect to the outcome variables, we compared patients with and without a psychiatric disorder, controlling for sociodemographic characteristics. RESULTS The average total costs of hospitalization (mean ± S.E.) for cardiovascular patients without psychiatric comorbidity and for patients with psychiatric comorbidity differed significantly (€5142 ± 210 vs. €7663 ± 571; d = 0.39). The increased costs for patients with psychiatric comorbidity were related to elevated returns, but the net gain for patients without psychiatric comorbidity was €277 ± 119. In contrast, the treatment of internal medicine patients with psychiatric disorders resulted in a net loss of -€624 ± 324 (overall group difference, d = -0.25). CONCLUSION Psychiatric comorbidity in cardiovascular inpatients leads to higher costs that are not reflected in the current reimbursement system in Germany. The inappropriate reimbursement of psychiatric comorbidity in cardiovascular inpatients may result in a serious undertreatment of these patients.
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Affiliation(s)
- Achim Hochlehnert
- Department of Psychosomatic and Internal Medicine II, University of Heidelberg, Heidelberg, Germany
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Boustani M, Baker MS, Campbell N, Munger S, Hui SL, Castelluccio P, Farber M, Guzman O, Ademuyiwa A, Miller D, Callahan C. Impact and recognition of cognitive impairment among hospitalized elders. J Hosp Med 2010; 5:69-75. [PMID: 20104623 PMCID: PMC2814975 DOI: 10.1002/jhm.589] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Older adults are predisposed to developing cognitive deficits. This increases their vulnerability for adverse health outcomes when hospitalized. OBJECTIVE To determine the prevalence and impact of cognitive impairment (CI) among hospitalized elders based on recognition by lCD-coding versus screening done on admission. DESIGN Observational cohort study. SETTING Urban public hospital in Indianapolis. PATIENTS 997 patients age 65 and older admitted to medical services between July 2006 and March 2008. MEASUREMENTS Impact of CI in terms of length of stay, survival, quality of care and prescribing practices. Cognition was assessed by the Short Portable Mental Status Questionnaire (SPMSQ). RESULTS 424 patients (43%) were cognitively impaired. Of those 424 patients with CI, 61% had not been recognized by ICD-9 coding. Those unrecognized were younger (mean age 76.1 vs. 79.1, P <0.001); had more comorbidity (mean Charlson index of 2.3 vs.1.9, P = 0.03), had less cognitive deficit (mean SPMSQ 6.3 vs. 3.4, P < 0.001). Among elders with CI, 163 (38%) had at least one day of delirium during their hospital course. Patients with delirium stayed longer in the hospital (9.2 days vs. 5.9, P < 0.001); were more likely to be discharged into institutional settings (75% vs. 31%, P < 0.001) and more likely to receive tethers during their care (89% vs. 69%, P < 0.001), and had higher mortality (9% vs. 4%, P = 0.09). CONCLUSION Cognitive impairment, while common in hospitalized elders, is under-recognized, impacts care, and increases risk for adverse health outcomes.
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Affiliation(s)
- Malaz Boustani
- Indiana University Center for Aging Research, Indiana University, Indianapolis, Indiana, USA.
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Schellhorn SE, Barnhill JW, Raiteri V, Faso VL, Ferrando SJ. A comparison of psychiatric consultation between geriatric and non-geriatric medical inpatients. Int J Geriatr Psychiatry 2009; 24:1054-61. [PMID: 19326400 DOI: 10.1002/gps.2221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors examine changes in psychiatric referral patterns for geriatric inpatients since last reported in the United States, more than 20 years ago, and compare geriatric psychiatric referrals to those of a non-geriatric cohort. METHOD Retrospective study comparing psychiatric diagnosis, treatment and aftercare of younger (ages 18-60 years, n = 474) and older (>60 years, n = 487) patients seen in psychiatric consultation in a large, urban, university-based tertiary care hospital setting. RESULTS Compared to previous reports in the literature, this cohort contains a notably higher percentage of the 'old-old' (>80 years), reflecting the general aging of those who are hospitalized. Compared to younger patients, geriatric inpatients were more commonly referred for psychiatric consultation, but overall rates of referral remain low (<4%). Geriatric patients were diagnosed with dementia and delirium more frequently; with substance dependence less frequently; and were just as likely to be diagnosed with depression. Geriatric patients were also more likely to receive atypical antipsychotic medications and less likely to receive benzodiazepines than younger patients. In patients diagnosed with depression, psychiatric follow-up is more likely relegated to outpatient geriatricians and nursing homes. CONCLUSIONS Consulting psychiatrists frequently encounter geriatric patients and, given patterns of diagnosis and aftercare, should play a major role in medical staff education and in development of enhanced in-hospital and aftercare services, including psychiatric liaison.
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Affiliation(s)
- Sarah E Schellhorn
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston MA, USA
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Chen LM, Freitag MH, Franco M, Sullivan CD, Dickson C, Brancati FL. Natural history of late discharges from a general medical ward. J Hosp Med 2009; 4:226-33. [PMID: 19388081 DOI: 10.1002/jhm.413] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Slow hospital discharges reduce efficiency and compromise care for patients awaiting a bed. Although efficient discharge is a widely held goal, the natural history of the discharge process has not been well studied. OBJECTIVE To describe the discharge process and identify factors associated with longer and later discharges. DESIGN Prospective cohort study. SETTING A general medicine ward without house-staff coverage, in a tertiary care hospital (The Johns Hopkins Hospital) in Baltimore, Maryland, from January 1, 2005 to April 30, 2005. PATIENTS Two hundred and nine consecutively discharged adult inpatients. MEASUREMENTS Discharge time (primary outcome) and discharge duration (secondary outcome). RESULTS Median discharge time was 3:09 PM (25th% to 75th%: 1:08 to 5:00 PM). In adjusted analysis, discharge time was associated with ambulance used on discharge (1.5 hours), prescriptions filled prior to discharge (1.4 hours), subspecialty consult prior to discharge (1.2 hours), and procedure prior to discharge (1.1 hours). Median duration of the discharge process was 7 hours 34 minutes (25th% to 75th%: 4.0 to 22.0 hours). Discharge duration was associated with discharge to a location other than home (28.9 hours), and with need for consultation (14.8 hours) or a procedure (13.4 hours) prior to discharge (all P values <0.05). CONCLUSIONS Discharge time and duration have wide variability. Longer and later discharges were associated with procedures and consults. Successful efforts to decrease time of discharge will require broad institutional effort to improve delivery of interdepartmental services.
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Affiliation(s)
- Lena M Chen
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, 150 S.Huntington Ave., Boston, MA 02130, USA.
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Christodoulou C, Fineti K, Douzenis A, Moussas G, Michopoulos I, Lykouras L. Transfers to psychiatry through the consultation-liaison psychiatry service: 11 years of experience. Ann Gen Psychiatry 2008; 7:10. [PMID: 18702804 PMCID: PMC2531178 DOI: 10.1186/1744-859x-7-10] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 08/14/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are only a few reports on issues related to patient transfer from medical and surgical departments to the psychiatric ward by the consultation-liaison psychiatry service, although it is a common practice. Here, we present a study assessing the factors that influence such transfers. METHOD We examined the demographic and clinical backgrounds of a group of patients transferred from internal medicine and surgery to the psychiatric ward over an 11-year period. A comparison was made of this data with data obtained from a group of non-transferred patients, also seen by the same consultation-liaison psychiatry service. RESULTS According to our findings, the typical transferred patient, either female or male, is single, divorced or widowed, lives alone, belongs to a lower socioeconomic class, presents initially with (on the whole) a disturbed and disruptive behaviour, has had a recent suicide attempt with persistent suicidal ideas, suffers from a mood disorder (mainly depressive and dysthymic disorders), has a prior psychiatric history as well as a prior psychiatric inpatient treatment, and a positive diagnosis on axis II of the five axis system used for mental health diagnosis. CONCLUSION The transfer of a patient to the psychiatric ward is a decision depending on multiple factors. Medical diagnoses do not seem to play a major role in the transfer to the psychiatric ward. From the psychiatric diagnosis, depressive and dysthymic disorders are the most common in the transferred population, whilst the transfer is influenced by social factors regarding the patient, the patient's behaviour, the conditions in the ward she/he is treated in and any recent occurrence(s) that increase the anxiety of the staff.
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Affiliation(s)
- Christos Christodoulou
- Second Department of Psychiatry, University of Athens Medical School, 'Attikon' General Hospital, 1 Rimini Street, 124 62, Athens, Greece.,Department of Psychiatry, General Hospital of Athens 'G. Gennimatas', 154 Mesogion Avenue, 115 27, Athens, Greece
| | - Katerina Fineti
- Second Department of Psychiatry, University of Athens Medical School, 'Attikon' General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Athanasios Douzenis
- Second Department of Psychiatry, University of Athens Medical School, 'Attikon' General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - George Moussas
- Second Department of Psychiatry, University of Athens Medical School, 'Attikon' General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Ioannis Michopoulos
- Second Department of Psychiatry, University of Athens Medical School, 'Attikon' General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Lefteris Lykouras
- Second Department of Psychiatry, University of Athens Medical School, 'Attikon' General Hospital, 1 Rimini Street, 124 62, Athens, Greece
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Owoeye OA, Aina OF, Omoluabi PF, Olumide YM. An assessment of emotional pain among subjects with chronic dermatological problems in Lagos, Nigeria. Int J Psychiatry Med 2007; 37:129-38. [PMID: 17953231 DOI: 10.2190/h275-837t-844p-030h] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In dermatology, it is known that there is a significant co-morbidity between dermatological disorders and psychological complications, and it has been estimated that in at least one-third of patients with skin diseases, their effective management involves consideration of associated emotional factors. In Africa, particularly Nigeria, despite the prevalent dermatological disorders with their possible attendant mental health complications, little or no work has been done in the field of psycho-dermatology, hence the rationale for this study. METHODS A prospective study was carried out in the dermatology/venerology clinic of Lagos University Teaching Hospital (LUTH). Ethical clearance and consent were obtained to conduct the study. The subjects were selected by simple random sampling from adult patients that have had their dermatological disorders for at least six months before presentation in the clinic. Those with other co-existing chronic medical illness such as hypertension, diabetes, or haemoglobinopathy were excluded from the study. Controls were obtained to match for age and sex from apparently healthy workers in a nearby general hospital. Each subject was evaluated with a questionnaire to obtain necessary socio-demographic data: Psychache scale (PAS), and subscales C, D, and J of Symptom Check List (SCL-90). The data generated was analyzed to obtain means, and t-test was used to compare the means; p = 0.05 was taken as being significant. The analyses were done using SPSS version 10. RESULTS Eighty subjects with dermatological disorders, and of equal sex distribution, were evaluated, with mean age of 33 +/- 12.1 years. Equal number of controls matched for sex and mean age of 34.6 +/- 7.3 years were also evaluated. Among the subjects, 16.3% had Acne, followed by Urticaria (13.8%), Vitiligo (12.5%), Tinea (11.3%), Hansen's disease (5%), and others (41.1%). From assessment with PAS and SCL subscales, the mean scores by the subjects were much higher than those of the controls and in each group the males scored slightly higher than their female counterparts. On assessment with PAS, the subjects had much higher mean score of 28.94 +/- 12.61 and the controls: 18.92 +/- 7.1 with "t" of 6.19*; and the difference was statistically significant at p < 0.05 and critical "t" of 1.66. On SCL; subscale C, the mean scores for the subjects and controls were: 7.89 +/- 7.69 and 5.02 +/- 5.23 respectively and the difference was statistically significant with "t" of 2.75*. For subscale D, the mean score by the subjects was 11.09 +/- 10.56, and the controls had 4.84 +/- 6.08; and statistically significant difference with "t" of 4.59*. On subscale J, the subjects' mean score was 4.68 +/- 5.44, the controls: 1.98 +/- 3.19 with statistically significant "t" of 3.83*. CONCLUSIONS The results showed that subjects with dermatological disorders suffered from significant emotional pain when compared to the healthy controls; the males had higher mean scores on PAS and SCL subscales, hence more likely to suffer emotional pain than their female counterparts. Finally, the need to have consultation-liaison psychiatry in the dermatology facilities in Nigeria was emphasized.
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Affiliation(s)
- O A Owoeye
- Psychiatric Hospital, Yaba, Lagos, Nigeria
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Rentsch D, Dumont P, Borgacci S, Carballeira Y, deTonnac N, Archinard M, Andreoli A. Prevalence and treatment of depression in a hospital department of internal medicine. Gen Hosp Psychiatry 2007; 29:25-31. [PMID: 17189741 DOI: 10.1016/j.genhosppsych.2006.08.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 08/25/2006] [Accepted: 08/25/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Depressive disorders are overrepresented among patients admitted to nonpsychiatric units of general hospitals, but the majority of depressed patients are not identified in this setting. Effective and well-tolerated treatments and reliable diagnostic criteria, together with new assessment tools (self-administered or not), have been developed with encouraging results. Nevertheless, few studies have utilized standardized instruments and extensive clinical interviews by well-trained psychiatrists to assess depression. New research should test these tools in a French-speaking environment. METHODS The investigation covered 292 patients aged 18-65 who were admitted over a period of 6 months to the internal medicine units of Geneva University Hospitals. Each patient filled in a self-administered questionnaire for depression [Patient Health Questionnaire (PHQ-9)]; 212 patients were also evaluated by a psychiatrist using DSM-IV diagnostic assessment and the Hamilton Depression Rating Scale during the first week of their hospital stay; both assessments were single-blinded. RESULTS Psychiatric clinical interviews identified a high proportion (26.9%) of depressive disorders (37% among women) for all diagnoses; 11.3% (17.3% among women) of the patients met the DSM-IV criteria for major depression. The PHQ-9 identified depressive disorders among 34.9% of patients (42% among women) and identified a major depressive syndrome among 18.4% of patients (29.6% among women). Physicians in the internal medicine unit identified only about half the depressive patients; at the time of psychiatric examination, fewer than one in four patients was receiving antidepressant therapy. CONCLUSIONS Our findings confirm the results of previous investigations, which showed that the failure to detect and treat depression is a major health problem among patients admitted to nonpsychiatric units of a general hospital.
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Affiliation(s)
- Denis Rentsch
- Service d'accueil, d'urgences et de liaison psychiatriques, Unité de psychiatrie de liaison, University Hospitals of Geneva, 1211 Geneva, Switzerland.
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Abstract
Medical inpatients often suffer from comorbid psychiatric illness, which has been shown in previous studies to be associated with longer hospital stays. The present analysis used a large representative dataset to examine the impact of patient demographic and clinical characteristics on the relationship between psychiatric comorbidity and hospital length of stay. Analyses showed the existence of a psychiatric comorbidity predicted longer hospital stays for medical inpatients. However, in comparison to previous research, this effect was attenuated in this sample. Patients with mental disorders who were elderly, on Medicare, and those with schizophrenia or mood disorders were especially at risk for slightly longer lengths of stay.
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Affiliation(s)
- Sara K Bressi
- Bryn Mawr Graduate School of Social Work and Social Research, 300 Airdale Road, Bryn Mawr, PA 19010, USA.
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Bourgeois JA, Kremen WS, Servis ME, Wegelin JA, Hales RE. The Impact of Psychiatric Diagnosis on Length of Stay in a University Medical Center in the Managed Care Era. PSYCHOSOMATICS 2005; 46:431-9. [PMID: 16145188 DOI: 10.1176/appi.psy.46.5.431] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Inpatient use data were examined for fiscal years 1999-2001. Patients with and without psychiatric diagnoses were compared for length of hospital stay and complexity of illness. Patients with psychiatric disorders represented 33%-35% of total cases. Substance use (9,824 cases), mood disorders (2,524 cases), and cognitive disorders (2,362 cases) were the most common psychiatric illnesses. Patients with substance use disorders or no psychiatric diagnosis had the shortest adjusted length of stay, whereas the small number with adjustment disorders (N=147) had the longest. Other psychiatric patients had lengths of stay between these extremes. Excepting substance use disorders, increased lengths of stay with psychiatric comorbidity have persisted into the managed care era.
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Affiliation(s)
- James A Bourgeois
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, 2230 Stockton Blvd., Sacramento, CA 95817, USA.
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Webber AP, Martin JL, Harker JO, Josephson KR, Rubenstein LZ, Alessi CA. Depression in older patients admitted for postacute nursing home rehabilitation. J Am Geriatr Soc 2005; 53:1017-22. [PMID: 15935027 DOI: 10.1111/j.1532-5415.2005.53322.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the prevalence, recognition, and persistence of depression in older adults undergoing postacute rehabilitation in a nursing home (NH) setting and to explore the effect of depression on rehabilitation outcomes. DESIGN Prospective cohort study. SETTING One rehabilitative NH in the Los Angeles area. PARTICIPANTS One hundred fifty-eight patients (aged >/=65) admitted for postacute rehabilitation over a 9-month recruitment period. MEASUREMENTS Depression was assessed using the 15-item Geriatric Depression Scale (GDS-15) or the Cornell Scale for Depression (in participants with dementia). Medical records were reviewed for documentation of depression and antidepressant use before and during the rehabilitative NH stay. Rehabilitation process was assessed using total amount of successfully completed therapy (minutes). Rehabilitation outcome was assessed using the motor component of the Functional Independence Measure (mFIM). Measures were performed at admission and 2 months later. RESULTS Of the 646 potentially eligible patients admitted during the study, 158 consented, and 151 were screened for depression. Forty-two (27.8%) had depressive symptoms (GDS=6 or Cornell=5). Of these, only 15 had a documented diagnosis of depression, and 12 were receiving antidepressants. Depression was associated with longer NH stay but not with discharge mFIM score. Two months later, depression persisted in 24 participants and was associated with worse mFIM (55.5+/-22.7 vs 67.0+/-23.7, depressed vs nondepressed; P=.03). CONCLUSION Depression was common, underrecognized, and undertreated in these postacute rehabilitation patients. Depression generally persisted and was associated with worse functional status at 2-month follow-up.
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Affiliation(s)
- Adam P Webber
- Geriatric Research, Education and Clinical Center, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California, USA.
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Koopmans GT, Donker MCH, Rutten FHH. Length of hospital stay and health services use of medical inpatients with comorbid noncognitive mental disorders: a review of the literature. Gen Hosp Psychiatry 2005; 27:44-56. [PMID: 15694218 DOI: 10.1016/j.genhosppsych.2004.09.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 09/16/2004] [Indexed: 11/26/2022]
Abstract
We reviewed 23 studies on the association between noncognitive mental disorders and the use of general health care services by medical patients admitted to a general hospital. Only studies with a prospective design and with a correction for possible confounding factors were included. In most studies, only service use during index admission was observed, but eight studies included a longer observation period during follow-up after hospital discharge. The 15 studies that were restricted to service use during index admission showed mixed results: length of hospital stay was related to common mental disorders in some studies, but other studies did not find such an association. The eight studies that used a longer observation period showed findings that are more consistent. They demonstrated mainly that symptoms or complaints of depression are related to a higher resource use within general medical services.
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Affiliation(s)
- Gerrit T Koopmans
- Department of Health Policy and Management, Erasmus University Medical Center, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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Bourgeois JA, Wegelin JA, Servis ME, Hales RE. Psychiatric Diagnoses of 901 Inpatients Seen by Consultation-Liaison Psychiatrists at an Academic Medical Center in a Managed Care Environment. PSYCHOSOMATICS 2005; 46:47-57. [PMID: 15765821 DOI: 10.1176/appi.psy.46.1.47] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors reviewed the diagnoses from all inpatient psychiatric consultations conducted by faculty psychiatrists during calendar year 2001 (N = 901) at an academic medical center In about 25% of the consultations, multiple psychiatric diagnoses were made. The most frequent diagnosis groups were mood (40.7%), cognitive (32.0%), and substance use disorders (18.6%). Among 671 consultations in which only one diagnosis was made, the rates of these diagnosis groups were 35.4%, 20.1%, and 10.2%, respectively. The findings were compared with the findings of 19 previous studies published over the past 27 years. Mood, cognitive, and substance use disorders remain major foci of consultation-liaison practice in the managed care era, although the rate of cognitive disorder diagnoses has increased. No evidence was found of a change over time in referral rates.
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Affiliation(s)
- James A Bourgeois
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA 95817, USA.
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Yakimo R, Kurlowicz LH, Murray RB. Evaluation of outcomes in Psychiatric Consultation-Liaison Nursing practice. Arch Psychiatr Nurs 2004; 18:215-27. [PMID: 15625661 DOI: 10.1016/j.apnu.2004.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This report describes and evaluates the current status of outcome analysis in Psychiatric Consultation-Liaison Nursing (PCLN) and offers suggestions for future development. The status of outcome evaluation generally in psychiatric nursing is described with attention given to the scope of practice of PCLN and outcomes used by psychiatric consultation-liaison nurses (PCLNs) to evaluate their interventions. An evaluation framework based on Donabedian's paradigm of structure, process, and outcome is presented and its applicability shown to PCLN. This framework is further explicated with regard to a review of published studies of PCLN within the outcome domains of cost reduction, satisfaction with services, changes in clinical status, and perceptions of work environment. Finally, recommendations for further development of outcomes in PCLN are offered, based on the strengths and limitations of the extant literature.
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Affiliation(s)
- Richard Yakimo
- Washington University School of Medicine, Department of Psychiatry, St. Louis, MO 63108, USA
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Savoca E. Sociodemographic correlates of psychiatric diseases: accounting for misclassification in survey diagnoses of major depression, alcohol and drug use disorders. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2004. [DOI: 10.1007/s10742-006-6827-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Saravay SM, Kaplowitz M, Kurek J, Zeman D, Pollack S, Novik S, Knowlton S, Brendel M, Hoffman L. How Do Delirium and Dementia Increase Length of Stay of Elderly General Medical Inpatients? PSYCHOSOMATICS 2004; 45:235-42. [PMID: 15123850 DOI: 10.1176/appi.psy.45.3.235] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to identify the proximate causes through which dementia and delirium extend length of stay (LOS) in elderly general hospital patients. Among 93 patients age >/=65 years admitted to a tertiary-care teaching hospital through the emergency department, admission ratings of cognitive impairment, delirium, and dementia predicted the emergence of mental and behavioral manifestations of delirium and dementia in the hospital and greater LOS. Mental and behavioral manifestations also predicted greater LOS. On average, mental manifestations appeared first and were followed by behavioral manifestations, and the appearance of both types of manifestations occurred before the mean LOS. The results suggest that elderly patients with dementia and/or delirium who become symptomatic after admission to a general hospital first show mental signs and symptoms, then show behavioral disturbances, which appear to be the proximate causes of greater LOS.
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McMullan R, Silke B, Bennett K, Callachand S. Resource utilisation, length of hospital stay, and pattern of investigation during acute medical hospital admission. Postgrad Med J 2004; 80:23-6. [PMID: 14760174 PMCID: PMC1757957 DOI: 10.1136/pmj.2003.007500] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe the patient demographic characteristics and organisational factors that influence length of stay (LOS) among emergency medical admissions. Also, to describe differences in investigation practice among consultant physicians and to examine the impact of these on LOS. DESIGN Prospective observational study. SETTING General medicine department of a teaching hospital in Belfast, UK. PARTICIPANTS Data were recorded for patients who were admitted as emergencies and reviewed on the post-take ward rounds (PTWR) attended by the investigation coordinator. OUTCOME MEASURES Non-laboratory investigations requested, LOS, and diagnosis on discharge. RESULTS Of 830 episodes evaluated, the median LOS was 7 days (interquartile range 3-12 days); this was significantly longer for admissions on Fridays (p = 0.0011) and for patients managed on medical wards (p<0.0001). There was a positive correlation between patient age and LOS (r = 0.32, p<0.0001). Chest radiographs (p = 0.002) and echocardiography (p = 0.015) were associated with a prolonged LOS; no investigations were associated with a shortened LOS. Diagnoses of congestive heart failure, respiratory disease, and cancer were associated with a longer LOS; a diagnosis of angina was associated with a shorter LOS. Considerable variation in investigation ordering, but no difference in LOS, was observed between consultants. High use of a given medical test did not correlate with high use of other tests. CONCLUSION A systematic means of dealing with the NHS resource crisis should include an improved organisational strategy as well as social care provision. A more unified approach to investigation practice should also have a sparing effect on resources.
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Affiliation(s)
- R McMullan
- Department of Infectious Disease, Royal Victoria Hospital, and General Internal Medicine, Belfast City Hospital, Belfast, UK
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Kinder A, Stephens S, Mortimer N, Sheldon P. Severe herpes zoster after infliximab infusion. Postgrad Med J 2004; 80:26. [PMID: 14760175 PMCID: PMC1757965 DOI: 10.1136/pmj.2003.014373] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Andreoli PBDA, Citero VDA, Mari JDJ. A systematic review of studies of the cost-effectiveness of mental health consultation-liaison interventions in general hospitals. PSYCHOSOMATICS 2003; 44:499-507. [PMID: 14597685 DOI: 10.1176/appi.psy.44.6.499] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A systematic review of cost-effectiveness analyses of mental health consultation-liaison interventions in general hospitals was conducted. Few studies have evaluated the cost-effectiveness of consultation-liaison interventions, and only two articles met the criteria for inclusion in the review. The comparable variable was length of the hospital stay. It could not be concluded that psychiatric consultation had an effect on the duration of hospital stays. In one of the studies, the group that received psychiatric consultation showed improvement in depressive symptoms. Additional studies would have been relevant to this review if they had replicated clinical practice by using a naturalistic research design.
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Boutin-Foster C, Ferrando SJ, Charlson ME. The Cornell Psychiatric Screen: a brief psychiatric scale for hospitalized medical patients. PSYCHOSOMATICS 2003; 44:382-7. [PMID: 12954912 DOI: 10.1176/appi.psy.44.5.382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psychiatric comorbidity among medicine inpatients is prevalent, yet no reliable screen for identifying need for psychiatric referrals exists. The Cornell Psychiatric Screen was developed as a brief, reliable, and valid screening tool. The items on the Cornell Psychiatric Screen assess a range of psychiatric conditions, including cognition and behavior, depressive symptoms, anxiety, drug and alcohol history, and the patient's desire to see a psychiatrist. Of the patients whose Cornell Psychiatric Screen results indicated possible psychopathology, 89% had documented psychiatric comorbidity according to DSM-IV criteria. On the basis of preliminary validation, the Cornell Psychiatric Screen appears to be a useful tool for identifying patients who require a psychiatric evaluation.
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Camus V, Viret C, Porchet A, Ricciardi P, Bouzourène K, Burnand B. Effect of changing referral mode to C-L Psychiatry for noncognitively impaired medical inpatients with emotional disorders. J Psychosom Res 2003; 54:579-85. [PMID: 12781313 DOI: 10.1016/s0022-3999(02)00460-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To test the effect of changing referral mode to Consultation-Liaison Psychiatry (C-L Psychiatry) by implementing early screening with systematic multidisciplinary management for emotional disorders in noncognitively impaired medical inpatients. METHOD A prospective pre- and postintervention controlled study in the internal medicine division of a university hospital. RESULTS Out of 515 patients admitted to the internal medicine ward during the study period, 176 were included in the study and gave their informed consent (male=63%); 81 in the control group and 95 in the intervention group. Except for the increase in referral rate to the C-L Psychiatry service (4-32%), there were no significant differences between the baseline and intervention periods either in terms of length of stay in the internal medicine ward and of use and costs of medical resources, or in terms of patients' satisfaction as regards attention paid to psychosocial issues during hospitalization. CONCLUSION As a result of changing referral mode to C-L Psychiatry, the lack of effect on length of stay and on medical consumption of medically ill inpatients should be considered in the context of the briefness of the hospitalization periods encountered. Furthermore, the change in referral process does not seem to increase patients' perception of the quality of care provided.
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Affiliation(s)
- Vincent Camus
- Geriatric Psychiatry Consultation-Liaison Unit, CHUV 1011, Lausanne, Switzerland.
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