Knorr Marius, Hofmann Andreas B, Miteva Dimitrina, Noboa Vanessa, Rauen Katrin, Frauenfelder Fritz, Seifritz Erich, Quednow Boris B, Vetter Stefan, Egger Stephan T
Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Faculty of Medicine, University San Francisco de Quito, Quito, Ecuador.
Front Psychiatry. 2022 Apr 27;13:842936. doi: 10.3389/fpsyt.2022.842936. eCollection 2022.
Day and time of admission influence treatment outcomes and prognosis in several medical specialties; this seems related to resources' ability. It is largely unknown whether this also applies to mental health services. We investigate the relationship between time of admission, patients' demographic and clinical profile, and treatment outcomes.
Demographic and clinical profiles of admitted and discharged patients to a general psychiatric ward between January 1st, 2013 and December 31st, 2020, were analyzed. In addition, we used the last year (i.e., 2020) to monitor rehospitalization. Time of admission was defined as weekdays (working day, weekend) and dayshifts (daytime, dusk, and dawn).
During the study period, 12,449 patient admissions occurred. The mean age of the sample was 48.05 ± 20.90 years, with 49.32% ( = 6,140) females. Most admissions ( = 10,542, 84%) occurred on working days. Two-fifths of admissions (39.7%, = 4,950) were compulsory, with a higher rate outside daytime hours. Patients had slight differences in the clinical profile, resulting from evaluating the different items of the Health of Nation Outcome Scale (HoNOS). Patients admitted on night shifts, weekends, and holidays showed a shorter length of stay; patients compulsorily admitted during daytime (disregarding the day of the week) had a longer length of stay. All patient groups achieved a robust clinical improvement (i.e., an HoNOS score reduction of around 50%), with similar readmission rates.
The main finding of our study is the relationship between "daytime hours" and fewer compulsory admissions, a result of the interplay between demographics, clinical characteristics, and out-of-clinic service availability (such as ambulatory psychiatric- psychological praxis; day-clinic; home-treatment). The differing clinical profile, in turn, determines differences in treatment selection, with patients admitted after office hours experiencing a higher rate of coercive measures. The shorter length of stay for out-of-office admissions might result from the hospitalization as an intervention. These results should encourage the implementation of outpatient crisis-intervention services, available from dusk till dawn.
入院日期和时间会影响多个医学专科的治疗效果和预后；这似乎与资源能力有关。目前很大程度上不清楚这是否也适用于精神卫生服务。我们调查入院时间、患者人口统计学和临床特征与治疗效果之间的关系。
分析了2013年1月1日至2020年12月31日期间入住并出院的普通精神科病房患者的人口统计学和临床特征。此外，我们利用最后一年（即2020年）来监测再次入院情况。入院时间定义为工作日（工作日、周末）和班次（白天、黄昏和黎明）。
在研究期间，共发生12449例患者入院。样本的平均年龄为48.05±20.90岁，女性占49.32%（n = 6140）。大多数入院（n = 10542，84%）发生在工作日。五分之二的入院（39.7%，n = 4950）是强制入院，非白天时段的比例更高。通过评估国家健康结果量表（HoNOS）的不同项目，患者在临床特征上存在细微差异。夜班、周末和节假日入院的患者住院时间较短；白天（不考虑星期几）强制入院的患者住院时间较长。所有患者组都实现了显著的临床改善（即HoNOS评分降低约50%），再入院率相似。
我们研究的主要发现是“白天时段”与较少的强制入院之间的关系，这是人口统计学、临床特征和门诊外服务可用性（如门诊精神心理诊疗、日间诊所、家庭治疗）相互作用的结果。反过来，不同的临床特征决定了治疗选择的差异，办公时间后入院的患者接受强制措施的比例更高。非办公时间入院的住院时间较短可能是由于住院作为一种干预措施。这些结果应鼓励实施从黄昏到黎明的门诊危机干预服务。
