Kreuzer Peter M, Günther Stefan, Simoes Jorge, Ziereis Michael, Langguth Berthold
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstrasse 84, 93053, Regensburg, Germany.
BMC Health Serv Res. 2020 Nov 13;20(1):1041. doi: 10.1186/s12913-020-05806-1.
A large proportion of admissions to psychiatric hospitals happen as emergency admissions and many of them occur out of core working hours (during the weekends, on public holidays and during night time). However, very little is known about what determines admission times and whether the information of admission time bears any relevance for the clinical course of the patients. In other words, do admission times correlate with diagnostic groups? Can accumulations of crises be detected regarding circadian or weekly rhythms? Can any differences between workdays and weekends/public holidays be detected? May it even be possible to use information on admission times as a predictor for clinical relevance and severity of the presented condition measured by the length of stay?
In the present manuscript we analyzed data derived from 37'705 admissions to the Psychiatric District Hospital of Regensburg located in the Southern part of Germany covering the years 2013 to 2018 with regard to ICD-10 diagnostic groups and admission times. The hospital provides 475 beds for in-patient treatment in all fields of clinical psychiatry including geriatrics and addiction medicine.
Several core questions could be answered based on our analysis: 1st Our analysis confirms that there is a high percentage of unheralded admissions out of core time showing broad variation. 2nd In contrary to many psychiatrists' misconceptions the time of admission has no relevant impact on the length of stay in the hospital. 3rd The predictive value of admission time regarding the allocation to ICD-10 diagnostic groups is low explaining only 1% of variability.
Taken together, our data reveal the enormous variation of admission times of psychiatric patients accounting for the need of adequate and consistent provision of personnel and spatial resources.
很大一部分精神病院的入院是急诊入院，其中许多发生在核心工作时间之外（周末、公共假日和夜间）。然而，对于决定入院时间的因素以及入院时间信息是否与患者的临床病程相关，我们知之甚少。换句话说，入院时间与诊断组有关联吗？能否检测到昼夜节律或每周节律方面的危机积累？工作日与周末/公共假日之间是否存在差异？甚至能否将入院时间信息用作预测住院时间所衡量的所呈现病情的临床相关性和严重程度的指标？
在本手稿中，我们分析了德国南部雷根斯堡精神病区医院2013年至2018年期间37705例入院患者的数据，涉及国际疾病分类第十版（ICD - 10）诊断组和入院时间。该医院为包括老年病学和成瘾医学在内的临床精神病学各个领域的住院治疗提供475张床位。
基于我们的分析可以回答几个核心问题：第一，我们的分析证实，非核心时间的意外入院比例很高，且差异很大。第二，与许多精神科医生的误解相反，入院时间对住院时间没有相关影响。第三，入院时间对ICD - 10诊断组分类的预测价值很低，仅解释了1%的变异性。
总体而言，我们的数据揭示了精神病患者入院时间的巨大差异，这表明需要充分且一致地提供人员和空间资源。
