Connolly M A, Ritchie S
Ravenscraig Hospital, Greenock.
Health Bull (Edinb). 1997 May;55(3):156-61.
To identify acute psychiatric patients considered inappropriately placed three months after admission and expedite a more suitable placement by improving liaison with social work.
A survey established the point prevalence of inappropriately placed patients. Changes in usual practice were implemented with the identification of a named social worker for each ward and the introduction of a 'contact sheet' which updated the progress of these patients monthly. A repeat survey one year later assessed the impact of these changes.
Gartnavel Royal Hospital, Greater Glasgow Community and Mental Health NHS Trust.
Patients aged 18-65 in the acute psychiatric wards who were resident beyond three months.
Use of the contact sheet and improved liaison with a named social worker did not shorten the length of stay of the inappropriately placed patients. Conversely, their mean value for in-patient weeks on the dates surveyed increased from 41.8 in 1994 to 64.7 in 1995. (p = 0.05, 95% confidence intervals from -1 to 42. The length of stay of patients who were still considered to be appropriately placed beyond three months after admission decreased from a mean of 47.7 to 31.9 weeks. (p > 0.5, 95% confidence intervals from -16 to 16). By 1995 the mean length of stay was significantly greater for inappropriately placed patients (p = 0.008, 95% confidence intervals from 10 to 47).
Improved liaison with social work at an operational level was not sufficient to solve the problem of inappropriately placed patients on acute wards. Additional factors such as limited access to rehabilitation placements and patients having complex physical or behavioural problems made placement elsewhere difficult. Such patients with unmet needs place increasing strain on acute psychiatric beds. A reappraisal of current services is required.
识别入院三个月后被认为安置不当的急性精神病患者，并通过改善与社会工作的联络来加快更合适的安置。
一项调查确定了安置不当患者的时点患病率。通过为每个病房指定一名社会工作者并引入“联系表”（每月更新这些患者的进展情况）来实施常规做法的改变。一年后进行的重复调查评估了这些变化的影响。
格拉斯哥大社区及心理健康国民保健服务信托基金的加特内韦尔皇家医院。
急性精神科病房中住院超过三个月的18至65岁患者。
使用联系表并改善与指定社会工作者的联络并未缩短安置不当患者的住院时间。相反，在调查日期，他们的平均住院周数从1994年的41.8周增加到1995年的64.7周。（p = 0.05，95%置信区间为-1至42。入院三个月后仍被认为安置得当的患者的住院时间从平均47.7周降至31.9周。（p > 0.5，95%置信区间为-16至16）。到1995年，安置不当患者的平均住院时间显著更长（p = 0.008，95%置信区间为10至47）。
在操作层面改善与社会工作的联络不足以解决急性病房中患者安置不当的问题。其他因素，如康复安置机会有限以及患者存在复杂的身体或行为问题，使得在其他地方安置困难。这些需求未得到满足的患者给急性精神病床位带来了越来越大的压力。需要对当前服务进行重新评估。
