Involuntary return to a psychiatric emergency service within twelve months.
OBJECTIVE
Under managed care, there is pressure to shorten hospital stays. Yet, previous investigations have shown longer hospitalizations following a psychiatric emergency service (PES) evaluation reduce recidivism. This study examines the relationship between post-PES hospitalization, patient characteristics and involuntary PES return within 12 months. It is done in a context where average duration of post-PES hospitalizations are 6 days, approximately 1/4 the duration of previous studies reporting positive effects of such hospitalization.


METHODS
Structured observations of PES evaluations of 417 patients were completed at 7 California county general hospitals. Follow-ups were conducted at 12 months after initial evaluation. Study objectives are evaluated using multivariate modeling.


RESULTS
Subsequent to the initial evaluation, 121 of the 417 patients (29.0%) were involuntarily returned to the PES. The likelihood of involuntary return was increased by a psychotic diagnosis and the seriousness of initial clinical presentations on the TRIAD dangerousness criterion measure. Having insurance also increased the likelihood of involuntary return.


CONCLUSIONS
As the patient's initial PES condition was found to be the best predictor of involuntary return and duration of post-PES hospitalization seemed to lose its prophylactic effect, it seems we have gone too far in reducing lengths of inpatient stays. We may have lost sight of the crucial role of this setting in stopping the revolving door and insuring appropriate care.
D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006766:Hospitals, County / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016013:Likelihood Functions; D008297:Male; D008329:Managed Care Programs; D015999:Multivariate Analysis; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000175:diagnosis / Q000628:therapy*; D012495:San Francisco