Crisis discharges and readmission risk in acute psychiatric male inpatients.
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).


CONCLUSIONS
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.
Department of Psychiatry, University of Stellenbosch, South Africa. djhn@sun.ac.za
Dana J H
DJ
Niehaus
Liezl
L
Koen
Ushma
U
Galal
Khalid
K
Dhansay
Piet P
PP
Oosthuizen
Robin A
RA
Emsley
Esme
E
Jordaan
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000534:rehabilitation; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data; D015897:Comorbidity; D006291:Health Policy; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology* / Q000534:rehabilitation; D013019:South Africa; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D013997:Time Factors