title: Reducing Length of Acute Inpatient Hospitalization Using a Residential Step Down Model for Patients with Serious Mental Illness.
abstract: Psychiatric inpatient bed numbers have been markedly reduced in recent decades often resulting in long emergency department wait times for acutely ill psychiatric patients. The authors describe a model utilizing short-term residential treatment to substitute for acute inpatient care when the barrier to discharge for patients with serious mental illness (SMI) is finding appropriate community placement. Thirty-eight patients (community hospital (n = 30) and a state hospital (n = 8)) were included. Clinical variables, pre-/post-step down length of stay, and adverse outcomes are reported. Thirty of the 38 patients completed treatment on the residential unit and were discharged to the community. Five of the patients required readmission to an inpatient unit and the other three had pre-planned state hospital discharges. The majority of patients with SMI awaiting placement can be stepped down to residential treatment, potentially freeing up an inpatient bed for an acutely ill patient. Reforms in healthcare funding are necessary to incentivize such an approach on a larger scale, despite likely cost savings.
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, NC, 27514, USA. theodore_zarzar@med.unc.edu0.
authors.forename: Theodore
authors.identifier: 0000-0002-8562-3359
authors.initials: T
authors.lastname: Zarzar
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Sheitman
authors.affiliation: Central Regional Hospital, 300 Veazey Road, Butner, NC, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Cook
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Robbins
mesh_terms: D000328:Adult; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D012114:Residential Treatment / Q000379:methods; D016896:Treatment Outcome
keywords: Length of stay; Residential treatment; Serious mental illness (SMI); State hospitals; Step down