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. 2008 Jun 17:8:44.
doi: 10.1186/1471-244X-8-44.

Crisis discharges and readmission risk in acute psychiatric male inpatients

Dana J H Niehaus  1 , Liezl Koen, Ushma Galal, Khalid Dhansay, Piet P Oosthuizen, Robin A Emsley, Esme Jordaan
Affiliations

Crisis discharges and readmission risk in acute psychiatric male inpatients

Dana J H Niehaus et al. BMC Psychiatry. .

Abstract

Background: Severe pressures on beds in psychiatric services have led to the implementation of an early ("crisis") discharge policy in the Western Cape, South Africa. The study examined the effect of this policy and length of hospital stay (LOS) on readmission rates in one psychiatric hospital in South Africa.

Methods: Discharge summaries of adult male patients (n = 438) admitted to Stikland Psychiatric Hospital during 2004 were retrospectively examined. Each patient's clinical course was then analysed for the period between January 1st, 2004, and August 31st, 2006.

Results: Although shorter LOS was associated with decreased readmission rates, the effect of crisis discharges was far more powerful. Patients discharged as usual had a far lower risk of readmission than those discharged due to bed pressures (i.e. crisis discharge).

Conclusion: Increased risks associated with the early discharge policy necessitate the urgent review of the current management of bed shortages in this inpatient facility. The strengthening of community initiatives, particularly assertive outreach could be a way forward.

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Figures

Figure 1
Figure 1
Kaplan-Meier survival curves for crisis status. The Kaplan-Meier curves showing the influence of crisis discharge on time to readmission. Crosses indicate where censoring took place. Plot includes 95% confidence intervals for the two Kaplan-Meier curves.
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