摘要
Background: Inpatient care constitutes the most expensive component of psychiatric services and pressure is increasingly being mounted on clinicians to discharge patients early. With the advent of managed care in Nigeria, psychiatrists as well as other physicians will be faced with the challenge of having to justify patient’s length of hospital admission. This study was designed to examine the factors that influence the length of stay (LOS) in an acute psychiatric ward.
Methods: A list of all patients admitted to the psychiatric unit of the UCH for the twelve month period between June 1st 2006 and May 31st 2007 was compiled from the ward admission registers. Data were extracted from the patient’s case notes using specially designed data record forms.
Results: There were a total of three hundred and seventy one (371) admissions made up of three hundred and thirty three (333) patients, out of which a total of 247 (74.5%) case notes were successfully reviewed. The most common diagnoses necessitating admission were schizophrenia and mood disorders. The mean LOS was 28.7 days and bed turnover for this period was 5.8. Factors found to be significantly associated with longer LOS include age, diagnosis, previous admissions and receiving electroconvulsive therapy with medication. These factors need to be considered in determining the period of hospitalization covered under managed care schemes.
Keywords: Length of stay, psychiatric admission, psychiatric diagnosis
Résumé
Contexte: Les soins d’hospitalisation constituent l’élément le plus coûteux des services psychiatriques et la pression est de plus en plus montée sur les cliniciens à donner tôt l’autorisation de sortie aux patients (malades). Avec l’avènement des soins gérés au Nigeria, les psychiatres ainsi que d’autres médecins seront confrontés au défi d’avoir à justifier la durée d’hospitalisation des patients. Cette étude a été conçue pour examiner les facteurs qui influencent la durée du séjour (LOS) dans un service psychiatrique spécialisé dans les soins urgents.
Méthodes: Une liste de tous les patients admis à l’unité psychiatrique du CHU pour une période de douze mois entre le 1er Juin 2006 et le 31 mai 2007 a été compilée à partir des registres d’admission des quartiers. Les données sont obtenues à partir des notes de cas du patient en faisant usage spécialement des formulaires conçus pour l’enregistrement des données.
Résultats: Il y avait un total de trois cent soixante- onze (371) admissions faites de trois cent trente-trois (333) patients, dont un total de 247 (74,5%) des notes de cas a été révisé avec succès. Les diagnostics les plus fréquents nécessitant l’admission étaient la schizophrénie et les troubles de l’humeur. La durée moyenne d’hospitalisation était de 28,7 jours et le chiffre d’affaires d’admis au lit pour cette période était de 5,8. Des facteurs significatifs sont associés à la durée d’hospitalisation y compris l’âge, le diagnostic, les admissions antérieures et bénéficiant d’une électro convulsivothérapie avec des médicaments.
Conclusion: Les facteurs tels que le diagnostic et les modalités de traitement qui prolongent la durée de séjour nécessitent une considération importante dans la détermination de la période d’hospitalisation couverte par les régimes de soins gérés.
Correspondence: Dr. BD Oladeji, Department of Psychiatry, College of Medicine, University of Ibadan, E-mail: bibideji@yahoo.com
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