The rapid stabilization pathway: impact of a brief inpatient intervention on the length of stay and readmissions among psychiatrically hospitalized adolescents

IF 6.8 3区医学 Q1 PEDIATRICS Child and Adolescent Mental Health Pub Date : 2023-01-09 DOI:10.1111/camh.12636

Deanna Palmeri Sams, David Garrison, Patrick Walsh, Daniel Maeng, Wendi Cross

{"title":"The rapid stabilization pathway: impact of a brief inpatient intervention on the length of stay and readmissions among psychiatrically hospitalized adolescents","authors":"Deanna Palmeri Sams, David Garrison, Patrick Walsh, Daniel Maeng, Wendi Cross","doi":"10.1111/camh.12636","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Background</h3>\n \n <p>Suicide is the second leading cause of death among adolescents in the United States (Centers for Disease Control and Prevention [CDC], 2017, Death rates due to suicide and homicide among persons age 10–24: United States, 2000–2017) constituting a significant public health crisis. The demand for psychiatric emergency services and inpatient beds is increasing, while the number of beds available decreases or remains static (National Association of State Mental Health Program Directors, 2017, Trend in psychiatric inpatient capacity, United States and Each State, 1970–2014. www.nasmhpd.org/sites/default/files/TACPaper.2.Psychiatric-Inpatient-Capacity_508C.pdf) leading to delays in treatment and exacerbation of symptoms for some adolescents awaiting care. This pilot project describes the development, feasibility, and acceptability of a creative, values-based safety planning intervention for adolescents hospitalized on an acute inpatient psychiatric unit and the impact of this intervention on length of stay and readmissions to acute psychiatric care.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Thirty patients experiencing a suicidal crisis participated in the Rapid Stabilization Pathway (RSP) during their inpatient psychiatric admission.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Results indicate that, compared to patients who underwent inpatient treatment as usual (TAU), RSP patients were discharged after a significantly shorter length of stay (4 vs. 6.1 weekdays respectively, <i>p</i> < .001). Further, there was no significant difference in readmission to the inpatient unit or to the psychiatric emergency room among RSP and TAU patients at 30, 60, and 90 days postdischarge.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>These findings have significant implications for acute inpatient programming. The RSP intervention treated patients in a shorter amount of time without any increase in re-admissions. Further, the shortened length of stay allowed for more patients to be treated on the inpatient unit and a significant cost savings. Future directions for programming and outcome research are discussed.</p>\n </section>\n </div>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"28 4","pages":"481-487"},"PeriodicalIF":6.8000,"publicationDate":"2023-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Child and Adolescent Mental Health","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/camh.12636","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 1

Abstract

Background

Suicide is the second leading cause of death among adolescents in the United States (Centers for Disease Control and Prevention [CDC], 2017, Death rates due to suicide and homicide among persons age 10–24: United States, 2000–2017) constituting a significant public health crisis. The demand for psychiatric emergency services and inpatient beds is increasing, while the number of beds available decreases or remains static (National Association of State Mental Health Program Directors, 2017, Trend in psychiatric inpatient capacity, United States and Each State, 1970–2014. www.nasmhpd.org/sites/default/files/TACPaper.2.Psychiatric-Inpatient-Capacity_508C.pdf) leading to delays in treatment and exacerbation of symptoms for some adolescents awaiting care. This pilot project describes the development, feasibility, and acceptability of a creative, values-based safety planning intervention for adolescents hospitalized on an acute inpatient psychiatric unit and the impact of this intervention on length of stay and readmissions to acute psychiatric care.

Methods

Thirty patients experiencing a suicidal crisis participated in the Rapid Stabilization Pathway (RSP) during their inpatient psychiatric admission.

Results

Results indicate that, compared to patients who underwent inpatient treatment as usual (TAU), RSP patients were discharged after a significantly shorter length of stay (4 vs. 6.1 weekdays respectively, p < .001). Further, there was no significant difference in readmission to the inpatient unit or to the psychiatric emergency room among RSP and TAU patients at 30, 60, and 90 days postdischarge.

Conclusions

These findings have significant implications for acute inpatient programming. The RSP intervention treated patients in a shorter amount of time without any increase in re-admissions. Further, the shortened length of stay allowed for more patients to be treated on the inpatient unit and a significant cost savings. Future directions for programming and outcome research are discussed.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

快速稳定途径：短期住院干预对精神科住院青少年住院时间和再次入院的影响。

背景：自杀是美国青少年死亡的第二大原因（美国疾病控制与预防中心，2017年，10-24岁人群自杀和凶杀死亡率：美国，2000-2017年），构成了一场重大的公共卫生危机。对精神病急诊服务和住院床位的需求正在增加，而可用床位数量减少或保持不变（美国国家精神卫生项目主任协会，2017年，美国和各州精神病住院容量趋势，1970-2014年）。www.nasmhpd.org/sites/default/files/TACPaper.2.Psychiatric-Inpatient-Capacity_508C.pdf）导致一些等待护理的青少年的治疗延迟和症状恶化。该试点项目描述了一种创造性的、基于价值观的安全规划干预措施的开发、可行性和可接受性，该干预措施适用于在急性住院精神科住院的青少年，以及该干预措施对急性精神科住院时间和再次入院的影响。方法：30名经历自杀危机的患者在住院期间参加了快速稳定通路（RSP）。结果：与正常住院治疗（TAU）患者相比，RSP患者在住院时间明显缩短后出院（分别为4个工作日和6.1个工作日，p结论：这些发现对急性住院规划具有重要意义。RSP干预在更短的时间内治疗患者，而不会增加再次入院的人数。此外，缩短的住院时间允许更多患者在住院部接受治疗，并显著节省了成本。规划的未来方向并对结果研究进行了讨论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Child and Adolescent Mental Health PEDIATRICS-PSYCHIATRY

CiteScore

8.30

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Child and Adolescent Mental Health (CAMH) publishes high quality, peer-reviewed child and adolescent mental health services research of relevance to academics, clinicians and commissioners internationally. The journal''s principal aim is to foster evidence-based clinical practice and clinically orientated research among clinicians and health services researchers working with children and adolescents, parents and their families in relation to or with a particular interest in mental health. CAMH publishes reviews, original articles, and pilot reports of innovative approaches, interventions, clinical methods and service developments. The journal has regular sections on Measurement Issues, Innovations in Practice, Global Child Mental Health and Humanities. All published papers should be of direct relevance to mental health practitioners and clearly draw out clinical implications for the field.