Too quick to discharge?

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In-hospital stays for major psychiatric illness can vary in length depending on the diagnosis and on a host of individual patient factors. During a rapid-fire talk session at APA2017, delegates heard how a longer length of stay (LOS) for patients with schizophrenia may be more important than it is for patients with other diagnoses – reducing their risk for subsequent readmission.

Readmission-risk is a concern for many patients hospitalized because of schizophrenia. Understanding the factors that might reduce that risk is important. New data reported at APA suggests in-patient length of stay (LOS), and in particular being discharged too soon, may put schizophrenia patients at increased risk for subsequent admissions.

A study of patients who had been hospitalized for acute episodes of schizophrenia, schizo-affective disorder, bipolar disorder or major depressive disorder, highlighted that readmission risks differ for different diagnoses, with patients with schizophrenia is particularly affected by their LOS before discharge.

Dr John Goethe, of Hartford Hospital in Connecticut, reported that while the mean LOS for all psychiatric diagnoses studied was 8 days, stays were around 50% longer in schizophrenia patients who had a mean LOS of 12 days.

 

How low can you go?

Interested in how different lengths of stay might impact on readmission risk, the study investigators looked at the differences between a LOS of 4 days and a LOS of 10 days on readmission risk at 180 days after discharge from hospital.

Longer LOS for schizophrenia patients reduced subsequent readmission risk

For patients with a diagnosis of schizophrenia, the shorter LOS of 4 days was associated with an increased risk for readmission as compared with a LOS of 10 days. Indeed with every incremental shortening of stay from 10 days down to 4, patients with schizophrenia were more likely to be readmitted again after discharge. These findings and trends were not so apparent in patients with schizo-affective disorder and seemed to be particular to patients with a schizophrenia diagnosis.

An opposite trend was noted in patients with major depressive disorder, where a shorter LOS appeared to reduce subsequent admission risk.

Dr Goethe concluded that the study data suggest that a longer LOS may be important in providing patients with schizophrenia with stability before their discharge.

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