December 1, 2002Open Access

Patterns and determinants of acute psychiatric readmissions

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute psychiatric illness (n=180). Intervention: Length of hospital stay and depot antipsychotics vs. Shorter length of stay and no depot antipsychotics. Primary outcome: Time to readmission.

Key Result

Neither length of hospital stay nor the use of depot neuroleptics significantly impacted the time to psychiatric readmission, whereas being married or cohabiting provided a significant protective effect (P=0.015).

Study Design

Type

Cohort (n=180)

Multicenter

PICO

Population

180 patients with acute psychiatric conditions admitted to a South African hospital, followed for 12 months to assess risk factors for readmission.

Exposure / Comparator

Length of hospital stay and depot antipsychotics vs Shorter length of stay and no depot antipsychotics

Primary Outcome

Time to readmission

Limitations

Small sample size
Record reviews limited diagnostic accuracy
Reliance on record reviews limited ability to track patients accurately, potentially leading to denominator loss
Strict criteria used for recording substance abuse and violence may have masked the contribution of these factors

Abstract

OBJECTIVES: Deinstitutionalisation and shortage of psychiatric beds worldwide has led to extensive research into the risk factors and interventions associated with rapid and recurrent admission to hospital. Little research of this nature has taken place in South Africa, particularly with regard to acute hospital admissions. This study attempted primarily to assess the effect of length of stay and administration of depot antipsychotics in hospital on time to readmission. DESIGN: A retrospective cohort of 180 admissions was followed up for 12 months, after an index discharge, by means of multiple hospital and community-based record reviews. Each readmission was analysed as an event using a survival analysis model. SETTING: Chris Hani Baragwanath Hospital, Gauteng. SUBJECTS: A random sample of patients admitted during a 6-month period in 1996. OUTCOME MEASURES: Time to readmission. RESULTS: Two hundred and eighty-four admissions were analysed. The only factor that provided a significant protective effect was being married or cohabiting (P = 0.015). Clinic attendance showed a slight protective effect early on but conferred a significantly higher risk of readmission on those who had been out of hospital for a long period (P = 0.001). Only 21% of discharged patients ever attended a clinic. The overall risk of readmission was significantly higher in the first 90 days post discharge. CONCLUSIONS: The lack of impact of length of hospital stay and use of depot neuroleptics on time to readmission may indicate that patients are being kept for appropriate duration and that the most ill patients are receiving depot medication. Several sampling and statistical artefacts may explain some of our findings. These results confirm the worldwide difficulty in finding consistent and accurate predictors of readmission. Low rates of successful referral to community aftercare need to be addressed before their effectiveness can be reasonably assessed. The inherent instability of the post-discharge period is a potential area for further investigation and intensive management.

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