Predictors of length of stay in an acute psychiatric inpatient facility in a general hospital: a prospective study

Baeza, Fernanda L.; da Rocha, Neusa S.; Fleck, Marcelo P.

doi:10.1590/1516-4446-2016-2155

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Brazilian Journal of Psychiatry

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Sumário

Original Article • rbp 40 (1) • Jan-Mar 2018 • https://doi.org/10.1590/1516-4446-2016-2155 copy

Predictors of length of stay in an acute psychiatric inpatient facility in a general hospital: a prospective study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

There have been significant reductions in numbers of psychiatric beds and length of stay (LOS) worldwide, making LOS in psychiatric beds an interesting outcome. The objective of this study was to find factors measurable on admission that would predict LOS in the acute psychiatric setting.

Methods:

This was a prospective, observational study.

Results:

Overall, 385 subjects were included. The median LOS was 25 days. In the final model, six variables explained 14.6% of the variation in LOS: not having own income, psychiatric admissions in the preceding 2 years, high Clinical Global Impression and Brief Psychiatric Rating Scale scores, diagnosis of schizophrenia, and history of attempted suicide. All variables were associated with longer LOS, apart from history of attempted suicide.

Conclusions:

Identifying patients who will need to stay longer in psychiatric beds remains a challenge. Improving knowledge about determinants of LOS could lead to improvements in the quality of care in hospital psychiatry.

Outcome studies; inpatient psychiatry; chronic psychiatric illness; administration; other delivery issues

Variable
Length of stay, median (IQR)	25 (16-36.5)
Age, mean (SD)	43.48 (15.0)
Male gender	195 (50.6)
Public health system users	283 (73.5)
Caucasian ethnicity	317 (82.3)
Area of residence: metropolitan	287 (74.5)
Educational level
Lower than middle school	139 (36.1)
Middle school	77 (20.0)
High school	122 (29.1)
Higher education	57 (14.8)
Employment status
Employed	93 (24.2)
Without own income	125 (32.5)
On sickness benefit/allowance	74 (19.2)
Retired	39 (10.1)
Disability allowance	54 (14.0)
Relationship status: without partner	262 (68.1)

Clinical characteristics
Previous psychiatric admission	257 (66.8)
History of hospital stays in the last 2 years (yes)	177 (46.0)
Number of previous psychiatric hospital stays, median (IQR)	3 (2-7)^* * Considering only the subsample with a history of hospital stays.
Previous suicide attempt	210 (54.5)
Number of previous suicide attempts, median (IQR)	2 (1-3)^† † Considering only the subsample with a history of suicide attempts.
Age in years at first diagnosis, median (IQR)	29 (20-40)
Time in years since first diagnosis, median (IQR)	8 (2-20)
Reason for admission
Suicide risk	170 (44.2)
Risk of aggression	92 (23.9)
Worsening of symptoms	76 (19.7)
Diagnostic uncertainty	23 (6.0)
Risk of moral exposure	20 (5.2)
Other	4 (1.0)
Main diagnosis (ICD-10)
(F00-F09) Organic, including symptomatic, mental disorders	8 (2.1)
(F20-F29) Schizophrenia, schizotypal, and delusional disorders	111 (28.8)
(F30-F39) Mood (affective) disorders	232 (60.3)
(F40-F48) Neurotic, stress-related, and somatoform disorders	13 (3.4)
(F60-F69) Disorders of adult personality and behavior	8 (2.1)
(F70-F79) Mental retardation	4 (1.0)
Others	5 (1.3)
CGI score, median (IQR)^‡ ‡ CGI was treated as a continuous variable.	6 (5-6)
BPRS score, median (IQR)	23 (16-32)
GAF score, median (IQR)	30 (20-40)

	Bivariate analysis		Multivariate analysis
	Step 0		Step 1	Step 2	Step 3	Step 4	Step 5	Step 6
	β standardized (p-value)	Adjusted R2	β standardized	β standardized	β standardized	β standardized	β standardized	β standardized
Age, years	-0.016 (0.749)	< 0.01
Female gender	0.011 (0.833)	< 0.01
Caucasian ethnicity	0.040 (0.437)	< 0.01
Area of residence: non-metropolitan	-0.023 (0.658)	< 0.01
Educational level: did not complete high school^* * Educational level was dummy-coded as a binary variable. with completion of high school or more as the reference category.	0.07 (0.172)	< 0.01
Without own income^† † Income was dummy-coded as a binary variable, with having own income as the reference category.	0.175 (0.001)	0.028^‡ ‡ R2 > 0.01.	0.114 (0.021)	0.112 (0.022)	0.110 (0.024)	0.109 (0.025)	0.110 (0.022)	0.111 (0.021)
Relationship status: without partner	0.014 (0.782)	< 0.01
Public health system user	0.083 (0.105)	< 0.01
Lifetime history of psychiatric admission	0.182 (0.001)	0.03^‡ ‡ R2 > 0.01.	0.035 (0.576)	0.036 (0.558)	0.040 (0.515)	0.041 (0.508)
Psychiatric admission in the preceding 2 years	0.160 (0.002)	0.023^‡ ‡ R2 > 0.01.	0.081 (0.174)	0.081 (0.175)	0.078 (0.186)	0.078 (0.187)	0.100 (0.039)	0.104 (0.033)
History of suicide attempt	-0.124 (0.015)	0.013^‡ ‡ R2 > 0.01.	-0.079 (0.137)	-0.081 (0.125)	-0.080 (0.129)	-0.079 (0.131)	-0.075 (0.150)	-0.096 (0.05)
Age at first diagnosis	-0.098 (0.055)^‡ ‡ R2 > 0.01.	< 0.01
Time since first diagnosis	0.098 (0.054)^‡ ‡ R2 > 0.01.	< 0.01
Cause of admission
Suicide risk	-0.181 (< 0.001)	0.03^‡ ‡ R2 > 0.01.	-0.058 (0.357)	-0.061 (0.323)	-0.057 (0.350)	-0.062 (0.266)	-0.069 (0.204)
Risk of aggression	0.115 (0.024)	0.011^‡ ‡ R2 > 0.01.	0.017 (0.761)	0.015 (0.789)	0.010 (0.858)
Worsening of symptoms	0.061 (0.235)	< 0.01
Diagnostic uncertainty	0.059 (0.246)	< 0.01
Risk of moral exposure	0.075 (0.142)	< 0.01
CGI	0.286 (< 0.001)	0.08^‡ ‡ R2 > 0.01.	0.202 (0.007)	0.186 (0.002)	0.188 (0.001)	0.188 (0.652)	0.192 (0.001)	0.188 (0.001)
BPRS	0.286 (< 0.001)	0.079^‡ ‡ R2 > 0.01.	0.098 (0.114)	0.094 (0.123)	0.093 (0.126)	0.094 (0.612)	0.095 (0.117)	0.102 (0.088)
GAF	-0.194 (< 0.001)	0.035^‡ ‡ R2 > 0.01.	0.025 (0.724)
Main diagnosis (ICD-10)
(F00-F09) Organic, including symptomatic, mental disorders	0.091 (0.077)	< 0.01
(F20-F29) Schizophrenia, schizotypal, and delusional disorders	0.231 (< 0.001)	0.051^‡ ‡ R2 > 0.01.	0.136 (0.085)	0.140 (0.075)	0.103 (0.054)	0.104 (0.792)	0.106 (0.046)	0.126 (0.013)
(F30-F39) Mood (affective) disorders	-0.168 (0.001)	0.026^‡ ‡ R2 > 0.01.	0.046 (0.566)	0.050 (0.524)
(F40-F48) Neurotic, stress-related, and somatoform disorders	-0.109 (0.034)	< 0.01
(F60-F69) Disorders of adult personality and behavior	-0.048 (0.352)	< 0.01
Intercept			2.313	2.4	2.441	2.446	2.453	2.424
R²			0.14	0.143	0.144	0.147	0.148	0.146

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[1] Correspondence: Fernanda Lucia Capitanio Baeza, Departamento de Psiquiatria, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, CEP 90035-205, Porto Alegre, RS, Brazil. E-mail: fernanda.baeza@gmail.com