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Keywords:

  • health services needs and demands;
  • health services research;
  • hospitals;
  • mental disorders;
  • epidemiology;
  • mental health services;
  • psychiatric

Objective:  To describe reasons for admission and alternatives to admission in a government funded acute inpatient unit.

Method:  Reasons for admission and alternatives to admission were rated for a consecutive sample of 255 admissions to an acute psychiatric unit in Auckland, using interviews with staff and case note review.

Result:  Most patients had a functional psychosis and were admitted involuntarily. Forty percent came from areas of marked social deprivation. The major reasons for admission were for reinstatement of medication (mainly linked to non-concordance with prescribed medication), intensive observation, risk to self and risk to others. Only 12% of admissions could have been diverted, of whom most would have required daily home treatment. For those still admitted at 5 weeks, 26% could have been discharged, mainly to 24 h nurse-staffed accommodation. If the alternatives had all been available, simulated bed-day savings were 11 bed years per year. Simulated bed day savings were greater through implementing early discharge than by diverting new admissions.

Conclusion:  Greater availability of assertive community treatment and of interventions to improve medication concordance may have prevented a small number of admissions. For patients admitted longer than 5 weeks, it appeared that greater availability of 24 h nurse-staffed accommodation would have allowed considerable bed-day savings.