Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study

Abstract

Objective: to investigate factors influencing length of stay and predictors for the risk of readmission at an acute psychiatric inpatient unit. Method: retrospective cross-sectional clinical file audit ranging four years back, a random selection of 378 patients was reviewed, including 178 cases and 200 controls. A case control study was employed in the study of length of stay, and for predictors of risk of readmission a retrospective cohort study was used. Results: the 7 variables that were associated with length of stay were: 1- instruction level, 2- place of origin, 3- use of restraints, 4- gender, 5- marital status, 6- drug class, and 7- number of visits. The 9 variables associated with risk of readmission were: 1- history of previous admission, 2- cognitive status, 3- use of seclusion, 4- diagnostic category (personality cluster, bipolar disorder, substance use disorder, adaptive disorder, situational crisis, acute alcoholic intoxication), 5- risk to others at the time of index admission, 6- instruction level, 7- age at first admission. Proactive and assertive treatment after discharge decreased the risk of readmission. Conclusions: Length of stay has predictable multifactorial determinants which are difficult to modify clinically, as inpatient quality of care was not associated with it. Good community network assisting practices appeared to be more likely to reduce risk of readmission.