Skip to main content
SpringerLink
Log in

Referral to Inpatient Treatment Does not Necessarily Imply a Need for Inpatient Treatment

  • Original Article
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

We analyzed the dispositional decisions taken in a unit for clinical decision making (UCDM) which was set up to examine all emergency inpatient referrals to a psychiatric hospital. Hospitalization proved unnecessary for at least 17 % of the N = 2,026 inpatient referrals over a one year period. Instead, these patients were admitted to day-hospitals or outpatient treatments, resulting in annual cost savings of approximately €3.3 million. Merely 8 % of those non-admitted patients had to be hospitalized within 28 days of the decision for non-admission being taken. Thus, a specialized UCDM run by clinical experts can help identify cost-effective alternatives to hospitalization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Amaddeo, F., Becker, T., Fioritti, A., Burti, L., & Tansella, M. (2007). Reforms in community care: The balance between hospital and community-based mental health care. In M. Knapp, D. McDaid, E. Mossialos, & G. Thornicroft (Eds.), Mental health policy and practice across europe (pp. 235–249). Berkshire: Open University Press.

    Google Scholar 

  • Becker, I., & Vazquez-Barquero, J. L. (2001). The European perspective of psychiatric reform. Acta Psychiatrica Scandinavica, 410, 8–14.

    Article  PubMed  Google Scholar 

  • Berhe, T., Puschner, B., Kilian, R., & Becker, T. (2005). “Home treatment” for mental illness. Concept definition and effectiveness. Nervenarzt, 76(7), 822–828, 830–821. doi:10.1007/s00115-004-1865-6.

  • Blitz, C. L., Solomon, P. L., & Feinberg, M. (2001). Establishing a new research agenda for studying psychiatric emergency room treatment decisions. Mental Health Services Research, 3(1), 25–34.

    Article  CAS  PubMed  Google Scholar 

  • Brooker, C., Ricketts, T., Bennett, S., & Lemme, F. (2007). Admission decisions following contact with an emergency mental health assessment and intervention service. Journal of Clinical Nursing, 16(7), 1313–1322. doi:10.1111/j.1365-2702.2007.01302.x.

    Article  PubMed  Google Scholar 

  • Catty, J., Burns, T., Knapp, M., Watt, H., Wright, C., Henderson, J., et al. (2002). Home treatment for mental health problems: A systematic review. Psychological Medicine, 32(3), 383–401.

    Article  CAS  PubMed  Google Scholar 

  • Douglass, A. M., Luo, J., & Baraff, L. J. (2011). Emergency medicine and psychiatry agreement on diagnosis and disposition of emergency department patients with behavioral emergencies. Academic Emergency Medicine, 18(4), 368–373. doi:10.1111/j.1553-2712.2011.01024.x.

    Article  PubMed  Google Scholar 

  • Fichtner, C. G., & Flaherty, J. A. (1993). Emergency psychiatry training and the decision to hospitalize: A longitudinal study of psychiatric residents. Academic Psychiatry, 17(3), 130–137. doi:10.1007/BF03341515.

    Article  CAS  PubMed  Google Scholar 

  • First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. W. (1997a). Structured clinical interview for DSM-IV Axis II personality disorders (SCID-II). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997b). Structured clinical interview for DSM-IV Axis I disorders (SCID-I), clinical version. Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Flaherty, J. A., & Fichtner, C. G. (1992). Impact of emergency psychiatry training on residents’ decisions to hospitalize patients. Academic Medicine, 67(9), 585–586.

    Article  CAS  PubMed  Google Scholar 

  • George, L., Durbin, J., Sheldon, T., & Goering, P. (2002). Patient and contextual factors related to the decision to hospitalize patients from emergency psychiatric services. Psychiatric Services, 53(12), 1586–1591.

    Article  PubMed  Google Scholar 

  • Glover, G., Arts, G., & Babu, K. S. (2006). Crisis resolution/home treatment teams and psychiatric admission rates in England. British Journal of Psychiatry, 189, 441–445. doi:10.1192/bjp.bp.105.020362.

    Article  PubMed  Google Scholar 

  • Jager, M., Sobocki, P., & Rossler, W. (2008). Cost of disorders of the brain in Switzerland with a focus on mental disorders. Swiss Medical Weekly, 138(1–2), 4–11.

    PubMed  Google Scholar 

  • Johnson, S., Nolan, F., Pilling, S., Sandor, A., Hoult, J., McKenzie, N., et al. (2005). Randomised controlled trial of acute mental health care by a crisis resolution team: The north Islington crisis study. British Medical Journal, 331(7517), 599. doi:10.1136/bmj.38519.678148.8F.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kuhl, H. C. (2008). Inpatient psychiatry in Switzerland 2000–2006 (Working Paper 31). Neuchatel: Swiss Health Observatory (Obsan).

    Google Scholar 

  • Low, L. F., & Draper, B. (2009). Hospitalization patterns for psychiatric disorders across the lifespan in Australia from July 1998 to June 2005. Psychiatric Services, 60(1), 113–116. doi:10.1176/appi.ps.60.1.113.

    Article  PubMed  Google Scholar 

  • Lyons, J. S., Stutesman, J., Neme, J., Vessey, J. T., O’Mahoney, M. T., & Camper, H. J. (1997). Predicting psychiatric emergency admissions and hospital outcome. Medical Care, 35(8), 792–800.

    Article  CAS  PubMed  Google Scholar 

  • Marshall, M., Crowther, R., Almaraz-Serrano, A., Creed, F., Sledge, W., Kluiter, H., et al. (2001). Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) acute day hospital versus admission; (2) vocational rehabilitation; (3) day hospital versus outpatient care. Health Technology Assessment Reports, 5(21), 1–75.

    CAS  Google Scholar 

  • Marshall, M., Crowther, R., Sledge, W. H., Rathbone, J., & Soares-Weiser, K. (2011). Day hospital versus admission for acute psychiatric disorders. Cochrane Database Systematic Reviews, 7(12), CD004026. doi:10.1002/14651858.CD004026.pub2.

    Google Scholar 

  • Marson, D. C., McGovern, M. P., & Pomp, H. C. (1988). Psychiatric decision making in the emergency room: a research overview. American Journal of Psychiatry, 145(8), 918–925.

    Article  CAS  PubMed  Google Scholar 

  • Mattioni, T., Di Lallo, D., Roberti, R., Miceli, M., Stefani, M., Maci, C., et al. (1999). Determinants of psychiatric inpatient admission to general hospital psychiatric wards: An epidemiological study in a region of central Italy. Social Psychiatry and Psychiatric Epidemiology, 34(8), 425–431.

    Article  CAS  PubMed  Google Scholar 

  • McGarvey, E. L., Leon-Verdin, M., Wanchek, T. N., & Bonnie, R. J. (2013). Decisions to initiate involuntary commitment: The role of intensive community services and other factors. Psychiatric Services, 64(2), 120–126. doi:10.1176/appi.ps.000692012.

    Article  PubMed  Google Scholar 

  • McNiel, D. E., Myers, R. S., Zeiner, H. K., Wolfe, H. L., & Hatcher, C. (1992). The role of violence in decisions about hospitalization from the psychiatric emergency room. American Journal of Psychiatry, 149(2), 207–212.

    Article  CAS  PubMed  Google Scholar 

  • Mulder, C. L., Koopmans, G. T., & Lyons, J. S. (2005). Determinants of indicated versus actual level of care in psychiatric emergency services. Psychiatric Services, 56(4), 452–457. doi:10.1176/appi.ps.56.4.452.

    Article  PubMed  Google Scholar 

  • Munizza, C., Furlan, P. M., d’Elia, A., D’Onofrio, M. R., Leggero, P., Punzo, F., et al. (1993). Emergency psychiatry: A review of the literature. Acta Psychiatrica Scandinavica, 374, 1–51.

    CAS  PubMed  Google Scholar 

  • Olfson, M., Ascher-Svanum, H., Faries, D. E., & Marcus, S. C. (2011). Predicting psychiatric hospital admission among adults with schizophrenia. Psychiatric Services, 62(10), 1138–1145. doi:10.1176/appi.ps.62.10.1138.

    Article  PubMed  Google Scholar 

  • Preti, A., Rucci, P., Santone, G., Picardi, A., Miglio, R., Bracco, R., et al. (2009). Patterns of admission to acute psychiatric in-patient facilities: A national survey in Italy. Psychological Medicine, 39(3), 485–496. doi:10.1017/S0033291708003607.

    Article  CAS  PubMed  Google Scholar 

  • Rabinowitz, J., Slyuzberg, M., Salamon, I., Dupler, S., Kennedy, R. S., & Steinmuller, R. (1995). A method for understanding admission decision making in a psychiatric emergency room. Psychiatric Services, 46(10), 1055–1060.

    Article  CAS  PubMed  Google Scholar 

  • Ruesch, P., Banziger, A., & Juvalta, S. (2013). Regional mental health care utilization and need for care in switzerland. data basis, statistical models, selected findings—An exploratory study (Obsan report 23). Neuchatel: Swiss Health Observatory.

    Google Scholar 

  • Sattar, S. P., Pinals, D. A., Din, A. U., & Appelbaum, P. S. (2006). To commit or not to commit: The psychiatry resident as a variable in involuntary commitment decisions. Academic Psychiatry, 30(3), 191–195. doi:10.1176/appi.ap.30.3.191.

    Article  PubMed  Google Scholar 

  • Schnyder, U., Valach, L., & Heim, E. (1995). Coping and the decision to hospitalize in emergency psychiatry. General Hospital Psychiatry, 17(5), 362–370..

    Article  CAS  PubMed  Google Scholar 

  • Stroul, B. A. (1988). Residential crisis services: A review. Hospital & Community Psychiatry, 39(10), 1095–1099.

    CAS  Google Scholar 

  • Swiss Conference of Health Ministers. (2008). Guide for the planing of psychiatric services. Bern: GDK.

    Google Scholar 

  • Talbott, J. A. (2004). Deinstitutionalization: Avoiding the disasters of the past. 1979. Psychiatric Services, 55(10), 1112–1115. doi:10.1176/appi.ps.55.10.1112.

    Article  PubMed  Google Scholar 

  • Thornicroft, G., Alem, A., Drake, R. E., Ito, H., Mari, J., McGeorge, P., Semrau, M. (Eds.). (2011). Community mental health: Putting policy into practice globally. Chichester: Wiley.

  • Thornicroft, G., & Tansella, M. (2003). What are the arguments for community-based mental health care? Copenhagen: WHO Regional Office for Europe.

    Google Scholar 

  • Thornicroft, G., & Tansella, M. (2004). Components of a modern mental health service: A pragmatic balance of community and hospital care: overview of systematic evidence. British Journal of Psychiatry, 185, 283–290. doi:10.1192/bjp.185.4.283.

    Article  PubMed  Google Scholar 

  • Thornicroft, G., & Tansella, M. (2009). Better mental health care. Cambridge: Cambridge University Press.

    Google Scholar 

  • Thornicroft, G., & Tansella, M. (2013). The balanced care model: The case for both hospital- and community-based mental healthcare. British Journal of Psychiatry, 202(4), 246–248. doi:10.1192/bjp.bp.112.111377.

    Article  PubMed  Google Scholar 

  • von Eye, A., Spiel, C., & Wood, P. K. (1996). Configural frequency analysis in applied psychological research. Applied Psychology, 45(4), 301–327.

    Google Scholar 

  • Way, B. B. (2005). Relationships between patient, family, and significant other disposition preferences in psychiatric emergency services and the clinical symptom ratings and disposition decisions of psychiatrists. Psychiatric Rehabilitation Journal, 29(2), 132–137.

    Article  PubMed  Google Scholar 

  • Way, B. B., & Banks, S. (2001). Clinical factors related to admission and release decisions in psychiatric emergency services. Psychiatric Services, 52(2), 214–218.

    Article  CAS  PubMed  Google Scholar 

  • Way, B. B., Evans, M. E., & Banks, S. M. (1992). Factors predicting referral to inpatient or outpatient treatment from psychiatric emergency services. Hospital & Community Psychiatry, 43(7), 703–708.

    CAS  Google Scholar 

  • Wiersma, D., Kluiter, H., Nienhuis, F. J., Ruphan, M., & Giel, R. (1995). Costs and benefits of hospital and day treatment with community care of affective and schizophrenic disorders. British Journal of Psychiatry, 27, 52–59.

    PubMed  Google Scholar 

  • Ziegenbein, M., Anreis, C., Bruggen, B., Ohlmeier, M., & Kropp, S. (2006). Possible criteria for inpatient psychiatric admissions: which patients are transferred from emergency services to inpatient psychiatric treatment? BMC Health Services Research, 6, 150. doi:10.1186/1472-6963-6-150.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interests

None.

Author information

Authors and Affiliations

  1. Psychiatric Services Aargau AG, P.O. Box 432, 5201, Brugg, Switzerland

    Niklaus Stulz, Anja Nevely, Matthias Hilpert, Daniel Bielinski, Caesar Spisla, Lienhard Maeck & Urs Hepp

Authors
  1. Niklaus Stulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anja Nevely
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias Hilpert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Bielinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Caesar Spisla
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lienhard Maeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Urs Hepp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Urs Hepp.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stulz, N., Nevely, A., Hilpert, M. et al. Referral to Inpatient Treatment Does not Necessarily Imply a Need for Inpatient Treatment. Adm Policy Ment Health 42, 474–483 (2015). https://doi.org/10.1007/s10488-014-0561-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-014-0561-5

Keywords

Search

Navigation