Shin Jinah, San Gabriel Maria Chona P, Ho-Periola Agnes, Ramer Sheryl, Kwon Youngihn, Bang Heejung
Nurse Practitioner, Private Practice, Great Neck, NY, USA.
Attending Psychiatrist, Icahn School of Medicine at Mount Sinai - Health and Hospitals, Elmhurst, NY, USA.
J Korean Acad Psychiatr Ment Health Nurs. 2022 Jun;31(2):181-191. doi: 10.12934/jkpmhn.2022.31.2.181. Epub 2022 Jun 30.
Psychiatric hospital length of stay (LOS) is not affected solely by socio-clinical factors but also by legal procedures. This study examined the associations between legal procedures and LOS.
Data from 521 patients with psychiatric illnesses hospitalized over 2013-2015 were analyzed. Logistic regression was used to evaluate the predictors of longer (> 14 days) or prolonged (> 30) LOS with socio-clinical factors and legal procedures including court-ordered interventions (assisted outpatient treatment, medication over objection, and retention).
Longer LOS occurred in 246 patients and 99 had prolonged LOS. Legal procedures affected 57 patients, with 11 assisted outpatient treatments, 39 cases of medication over objection, and 16 retentions. Longer LOS was significantly associated with six factors including older age, unmarried status, non-Hispanic race, risk of violence, schizophrenia, and legal procedures. Legal procedures had the strongest association. Longer/prolonged LOS yielded qualitatively similar associations.
Among 521 psychiatric inpatients, approximately 11% were mandated to receive interventions/procedures by the courts. Court-ordered legal procedures were strongly associated with longer LOS. Mental health providers may consider legal procedures for patients at high treatment/medication noncompliance risk as early as patient admission to inpatient units to prevent, intervene or prepare for a longer or prolonged LOS.
精神病医院的住院时长（LOS）不仅受社会临床因素影响，还受法律程序影响。本研究探讨了法律程序与住院时长之间的关联。
对2013年至2015年期间住院的521例精神病患者的数据进行分析。采用逻辑回归分析，评估社会临床因素和法律程序（包括法院命令的干预措施，如辅助门诊治疗、拒绝服药时的强制用药和强制留院）对住院时长超过14天或延长至超过30天的预测因素。
246例患者住院时间较长，99例患者住院时间延长。法律程序影响了57例患者，其中11例接受辅助门诊治疗，39例拒绝服药时被强制用药，16例被强制留院。住院时间较长与六个因素显著相关，包括年龄较大、未婚、非西班牙裔种族、暴力风险、精神分裂症和法律程序。法律程序的关联性最强。住院时间较长/延长产生了定性相似的关联。
在521例精神病住院患者中，约11%被法院强制要求接受干预措施/程序。法院命令的法律程序与较长的住院时长密切相关。心理健康服务提供者可在患者入住住院病房时，尽早考虑对治疗/服药依从性风险较高的患者采取法律程序，以预防、干预或应对较长或延长的住院时长。
