title: Increasing Access to State Psychiatric Hospital Beds: Exploring Supply-Side Solutions.
abstract: The objective of this study was to identify supply-side interventions to reduce state psychiatric hospital admission delays.
  
  
  
  Healthcare Enterprise Accounts Receivable Tracking System (HEARTS) data were collected for all patients admitted between July 1, 2010, and July 31, 2012, to one of North Carolina's three state-operated psychiatric hospitals (N=3,156). Additional information on hospital use was collected at nine meetings with hospital administrators and other local stakeholders. A discrete-event simulation model was built to simulate the flow of adult nonforensic patients through the hospital. Hypothetical scenarios were used to evaluate the effects of varying levels of increased capacity on annual number of admissions and average patient wait time prior to admission.
  
  
  
  In the base case, the model closely approximated actual state hospital utilization, with an average of 1,251±65 annual admissions and a preadmission wait time of 3.3±.1 days across 50 simulations. Results from simulated expansion scenarios highlighted substantial capacity shortfalls in the current system. For example, opening an additional 24-bed unit was projected to decrease average wait time by only 6%. Capacity would need to be increased by 165% (356 beds) to reduce average wait time below 24 hours.
  
  
  
  Without more robust community-based hospital and residential capacity, major increases in state psychiatric hospital inpatient capacity are necessary to ensure timely admission of people in crisis.
authors.affiliation: When this research was conducted, Dr. La was a doctoral student in the Department of Health Policy and Management, University of North Carolina at Chapel Hill, where Dr. Lich and Dr. Morrissey are affiliated. Dr. La is now with RTI Health Solutions, Morrisville, North Carolina (e-mail: lizla@rti.org ). Dr. Morrissey is also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, where Dr. Ellis is affiliated. Dr. Ellis is also with the Department of Social Work, North Carolina State University, Raleigh. Dr. Wells is with the Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Zhu is with the Department of Biostatistics, University of North Carolina at Chapel Hill, and with the Department of Statistics, University of Illinois at Urbana-Champaign.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: La
authors.affiliation: When this research was conducted, Dr. La was a doctoral student in the Department of Health Policy and Management, University of North Carolina at Chapel Hill, where Dr. Lich and Dr. Morrissey are affiliated. Dr. La is now with RTI Health Solutions, Morrisville, North Carolina (e-mail: lizla@rti.org ). Dr. Morrissey is also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, where Dr. Ellis is affiliated. Dr. Ellis is also with the Department of Social Work, North Carolina State University, Raleigh. Dr. Wells is with the Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Zhu is with the Department of Biostatistics, University of North Carolina at Chapel Hill, and with the Department of Statistics, University of Illinois at Urbana-Champaign.
authors.forename: Kristen Hassmiller
authors.initials: KH
authors.lastname: Lich
authors.affiliation: When this research was conducted, Dr. La was a doctoral student in the Department of Health Policy and Management, University of North Carolina at Chapel Hill, where Dr. Lich and Dr. Morrissey are affiliated. Dr. La is now with RTI Health Solutions, Morrisville, North Carolina (e-mail: lizla@rti.org ). Dr. Morrissey is also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, where Dr. Ellis is affiliated. Dr. Ellis is also with the Department of Social Work, North Carolina State University, Raleigh. Dr. Wells is with the Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Zhu is with the Department of Biostatistics, University of North Carolina at Chapel Hill, and with the Department of Statistics, University of Illinois at Urbana-Champaign.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wells
authors.affiliation: When this research was conducted, Dr. La was a doctoral student in the Department of Health Policy and Management, University of North Carolina at Chapel Hill, where Dr. Lich and Dr. Morrissey are affiliated. Dr. La is now with RTI Health Solutions, Morrisville, North Carolina (e-mail: lizla@rti.org ). Dr. Morrissey is also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, where Dr. Ellis is affiliated. Dr. Ellis is also with the Department of Social Work, North Carolina State University, Raleigh. Dr. Wells is with the Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Zhu is with the Department of Biostatistics, University of North Carolina at Chapel Hill, and with the Department of Statistics, University of Illinois at Urbana-Champaign.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Ellis
authors.affiliation: When this research was conducted, Dr. La was a doctoral student in the Department of Health Policy and Management, University of North Carolina at Chapel Hill, where Dr. Lich and Dr. Morrissey are affiliated. Dr. La is now with RTI Health Solutions, Morrisville, North Carolina (e-mail: lizla@rti.org ). Dr. Morrissey is also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, where Dr. Ellis is affiliated. Dr. Ellis is also with the Department of Social Work, North Carolina State University, Raleigh. Dr. Wells is with the Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Zhu is with the Department of Biostatistics, University of North Carolina at Chapel Hill, and with the Department of Statistics, University of Illinois at Urbana-Champaign.
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Swartz
authors.affiliation: When this research was conducted, Dr. La was a doctoral student in the Department of Health Policy and Management, University of North Carolina at Chapel Hill, where Dr. Lich and Dr. Morrissey are affiliated. Dr. La is now with RTI Health Solutions, Morrisville, North Carolina (e-mail: lizla@rti.org ). Dr. Morrissey is also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, where Dr. Ellis is affiliated. Dr. Ellis is also with the Department of Social Work, North Carolina State University, Raleigh. Dr. Wells is with the Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Zhu is with the Department of Biostatistics, University of North Carolina at Chapel Hill, and with the Department of Statistics, University of Illinois at Urbana-Champaign.
authors.forename: Ruoqing
authors.initials: R
authors.lastname: Zhu
authors.affiliation: When this research was conducted, Dr. La was a doctoral student in the Department of Health Policy and Management, University of North Carolina at Chapel Hill, where Dr. Lich and Dr. Morrissey are affiliated. Dr. La is now with RTI Health Solutions, Morrisville, North Carolina (e-mail: lizla@rti.org ). Dr. Morrissey is also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, where Dr. Ellis is affiliated. Dr. Ellis is also with the Department of Social Work, North Carolina State University, Raleigh. Dr. Wells is with the Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. Dr. Zhu is with the Department of Biostatistics, University of North Carolina at Chapel Hill, and with the Department of Statistics, University of Illinois at Urbana-Champaign.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Morrissey
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006742:Hospital Bed Capacity; D006778:Hospitals, Psychiatric / Q000600:supply & distribution*; D006783:Hospitals, State / Q000600:supply & distribution*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D055815:Young Adult