Psychiatric inpatient care at a county hospital before and after the inception of a university-affiliated psychiatry residency program.
OBJECTIVE
The University of California, Los Angeles (UCLA), along with Kern Medical Center (KMC) and Kern County Mental Health (KCMH), established a new psychiatry residency program in 2004. In this study, we compared psychiatric care at a county psychiatric facility serving a population of 760,000 inhabitants before and after the initiation of this psychiatry residency program.


METHODS
Medical charts for all patients admitted to the psychiatric inpatient service during the year before the inception of the psychiatry residency program (2003-2004) and during the first year in which there was full implementation of residents after inception of the psychiatry residency program (2005-2006) were reviewed. Baseline characteristics, demographics, and various outcomes of the two groups were compared.


RESULTS
After the residency program was established, the mean length of stay increased from 8.8 to 9.8 days (p < 0.05), the 30-day readmission rate increased from 3.5% (32/915) to 5.6% (48/853) (p < 0.05), more intramuscular emergency medications were given (p < 0.01), and more radiological assessments were obtained (p < 0.01). However, there was less delay in discharge (p < 0.01) and fewer days without medical necessity (p < 0.01). The patient satisfaction rate dropped from 77% (547/711) to 70% (476/680) (p < 0.01) after initiation of the residency program.


CONCLUSIONS
The results of this study suggest a statistically significant difference in multiple characteristics of treatment after initiation of a psychiatry residency program in the psychiatric inpatient setting. More research is needed to identify strategies, such as guidelines to eliminate over-utilization of resources and methods to improve residents' competency, that may successfully enhance the quality of care provided by residents to psychiatric inpatients.
Woo
Benjamin K P
BK
University of California, Los Angeles, USA. bkpwoo@gmail.com
Ma
Albert Y
AY
D000328:Adult; D001294:Attitude to Health; D002140:California / Q000453:epidemiology; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D006300:Health Services Misuse; D006760:Hospitalization / Q000706:statistics & numerical data*; D006766:Hospitals, County / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008489:Medical Indigency / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D009935:Organizational Affiliation; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011570:Psychiatry / Q000193:education* / Q000379:methods / Q000458:organization & administration; D011787:Quality of Health Care; D012577:Schools, Medical / Q000458:organization & administration