(189) Factors Associated with Short Psychiatric Hospitalization Length of Stay After Transfer from Medical Hospital

Abstract: Background/Significance: Consult-liaison (CL) psychiatrists serve as the gatekeepers for psychiatric admission from the general hospital. It is imperative to know that our decision to psychiatrically commit someone is valid for ethical and moral reasons, as well as from a resource utilization standpoint given the limited amount of inpatient psychiatric beds in the United States (1). In our 2023 retrospective chart review, we analyzed factors associated with psychiatric length of stay (PHLOS) after transfer from a medical hospital to measure validity (2). We found that diagnoses of affective, anxiety, and personality disorders were associated with shorter PHLOS, suggesting that these admissions may be of lower utility and diversion may be appropriate in certain cases. We now turn our sights onto PHLOS less than 48 hours after transfer from the medical hospital to further expand on our work. We hypothesize that suicidal ideation without acts of furtherance, non-violent and impulsive suicide attempts, current substance use, connection to outpatient mental health care, and voluntary commitments are associated with these shorter duration psychiatric hospitalizations.



Methods: A retrospective chart review was conducted of all recorded transfers from our institution's tertiary care academic medical hospital to the psychiatric hospital from 2021 through 2023. Information recorded includes age, identified race and gender, psychiatric diagnosis, reason for psychiatric admission, presence of involuntary psychiatric admission, PHLOS, length of stay at medical hospital, presence of substance use disorder, presence of outpatient psychiatric treatment, and hours between suicidal ideation and suicide attempt if present. We compared the group of patients that had a psychiatric hospital length of stay of less than 48 hours with a randomized subset of those who had a psychiatric hospital length of stay of longer than 48 hours using t-tests for continuous variables and Chi-squared test for categorical variables.

Results: 85 patients were identified that had a PHLOS of less than 48 hours after transfer from our academic medical center. 1162 patients were identified that had a PHLOS of more than 48 hours. A randomized subset of 90 of these 1162 patients were chosen to participate in data collection. Average PHLOS of the former group was 1.3 days while average PHLOS of the latter group was 19.9 days. Chart review is ongoing.

Discussion: For CL psychiatrists, an understanding of which factors are likely to lead to brief psychiatric hospitalizations can help guide discussions with patients regarding the benefits and risks of psychiatric hospitalization as well as provide valuable predictive information for CL services. Also, CL psychiatric services and inpatient psychiatric hospitals can use associated variables to identify patients appropriate for diversion prior to psychiatric hospitalization.



References:

McBain RK, Cantor JH, Eberhart NK. Estimating Psychiatric Bed Shortages in the US. JAMA Psychiatry.2022;79(4):279–280.

Israel A, Plescia C, Gopalan P. Factors Associated With Psychiatric Hospital Length of Stay After Transfer From Medical Hospital. J Acad Consult Liaison Psychiatry. 2023 Nov-Dec;64(6):581-582.

Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: This topic advances diversity, equity, and inclusion by informing consultation-liaison psychiatry services when discharges are likely to occur quickly after transfer to psychiatric hospital. This may allow easier diversion of patients and fewer involuntary hospitalizations which impact marginalized populations disproportionately.