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Markers of inappropriate placement in acute psychiatric inpatient care: a five hospital study

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Abstract

Background: Previous researchers in the UK have measured the prevalence of the `inappropriateness' of acute adult psychiatric inpatient placements by eliciting the judgements of health professionals. We extended the methodology by identifying inpatient sub-groups with stable characteristics that were associated with elevated risk of inappropriate placement, and by calculating the level of that risk. Methods: A 1-day census was taken in five hospitals. Using a structured instrument, consultant psychiatrists recorded judgements on current placements, recommended alternative placements and stated why alternatives had not been used. Judgements were obtained for 100% of the 261 inpatients. Risk ratios and adjusted odds ratios were calculated to identify sub-groups that were at high risk. Results: Eighty-eight inpatients were inappropriately placed, a point prevalence of 34% (95% CI 28–40%). Consultants recorded that services outside hospital, if available, could have supported most of these inpatients as an alternative to at least part of their hospital stay. Diagnostic rather than socio-demographic or administrative characteristics, in particular primary diagnoses of substance-related disorder, personality disorder, anxiety/stress, and schizophrenia with co-morbid substance misuse, were the strongest markers of elevated risk. Conclusions: The point prevalence of inappropriate placement within the British mental health-care system is considerable. Diagnostic categories are reasonable pragmatic markers. Further research should aim to identify a strong marker of risk within the numerically large sub-group of schizophrenia without substance misuse.

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Accepted: 17 March 1999

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Bartlett, C., Evans, M., Holloway, J. et al. Markers of inappropriate placement in acute psychiatric inpatient care: a five hospital study. Soc Psychiatry Psychiatr Epidemiol 34, 367–375 (1999). https://doi.org/10.1007/s001270050157

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Keywords

  • Schizophrenia
  • Personality Disorder
  • Point Prevalence
  • Psychiatric Inpatient
  • Substance Misuse