Alternatives to psychiatric in-patient care: A case-by-case survey of clinician judgements

Abstract

Acute psychiatric beds in the UK are under pressure. More beds are often called for, yet conceivably many in-patients might benefit from alternative care-settings. We studied an admissions cohort of 730 cases in four hospitals over a 5-month period. Using a structured instrument, Consultant Psychiatrists recorded an opinion, on a case-by-case basis, stating whether admission was divertible or whether discharge was delayed, recommending alternative placements where applicable. One hundred and seventy-nine of 543 cases with stays completed in the study period were deemed inappropriately placed at some point (33.0%, 95% CI 29.0 to 36.9), with 112 (21%) being divertible admissions. When surveyed systematically, clinicians reported that many in-patients could benefit from alternative caresettings, the majority being community-based services, although more specialised hospital beds were also needed. Divertible admissions are judged to impose more pressure on acute beds than delayed discharges, although a small number of difficult-to-place patients with protracted stays can occupy many bed-days.