Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
PLoS One. 2018 Aug 20;13(8):e0202569. doi: 10.1371/journal.pone.0202569. eCollection 2018.
Dedicated regional psychiatric emergency services (PES) were proposed as a better care model for psychiatric emergencies and a possible solution to boarding of psychiatric patients in the emergency department. However, there are limited data on factors associated with prolonged length of stay (LOS) in the PES. The objective of this study was finding factors associated with prolonged LOS in the PES and moving towards a solution to this problem.
The study sample comprised 200 PES visits randomly chosen from January 2011 to December 2015 in a psychiatric hospital in Taiwan. Relevant data were collected comprehensively through the health information system and by reviewing medical records. The primary outcome was LOS longer than 24 hours while LOS longer than 48 hours was used as the secondary outcome.
Mean LOS was 17.6±23.2 hours, with 53 (26.5%) visits lasting more than 24 hours and 15 (7.5%) visits lasting more than 48 hours. After adjusting for related confounders, LOS longer than 24 hours was associated with use of restraints in the PES (adjusted odds ratio (aOR) = 3.13, 95% CI = 1.59-6.15) and history of illicit substance use (aOR = 2.46, 95% CI = 1.11-5.44). LOS longer than 48 hours was associated with use of restraints in the PES (aOR = 4.11, 95% CI = 1.2-14.14), history of illicit substance use (aOR = 6.16, 95% CI = 1.37-27.62) and first time visit to the hospital (aOR = 8.54, 95% CI = 2.03-35.96). Neither outcome was associated with transfer to an inpatient unit.
Prolonged LOS was common in the study sample. Discharged patients had an equally high rate of prolonged LOS as admitted patients. Therefore measures should be taken to facilitate timely discharge. Use of restraints and history of illicit substance use were common among patients with prolonged LOS.
专门的地区精神科急诊服务（PES）被提议作为精神科急诊更好的护理模式，也是解决精神科患者在急诊部门住院的可能方案。然而，关于与 PES 中延长住院时间（LOS）相关的因素的数据有限。本研究的目的是寻找与 PES 中延长 LOS 相关的因素，并为解决这一问题寻找方法。
该研究样本包括 2011 年 1 月至 2015 年 12 月期间在台湾一家精神病院随机选择的 200 次 PES 就诊。通过健康信息系统和病历回顾，全面收集相关数据。主要结果是 LOS 超过 24 小时，LOS 超过 48 小时作为次要结果。
平均 LOS 为 17.6±23.2 小时，53 次（26.5%）就诊时间超过 24 小时，15 次（7.5%）就诊时间超过 48 小时。调整相关混杂因素后，PES 中使用约束（调整后的优势比（aOR）=3.13，95%置信区间（CI）=1.59-6.15）和非法药物使用史（aOR=2.46，95%CI=1.11-5.44）与 LOS 超过 24 小时相关。LOS 超过 48 小时与 PES 中使用约束（aOR=4.11，95%CI=1.2-14.14）、非法药物使用史（aOR=6.16，95%CI=1.37-27.62）和首次就诊（aOR=8.54，95%CI=2.03-35.96）有关。这两种结果都与转入住院病房无关。
在研究样本中，延长 LOS 很常见。出院患者的 LOS 延长率与住院患者相同。因此，应采取措施促进及时出院。使用约束和非法药物使用史在 LOS 延长的患者中很常见。
