The Psychiatric hospital最新文献

Charter Medical Corporation's computerized Clinical Information System is described. The computerized system helps clinicians formulate and document individualized patient treatment plans along the continuum of care and to improve internal medical record keeping. The system can also help improve the efficient collecting, storing, retrieving, and reporting of clinical information, both for internal use and for external utilization review and case management. In the future, the system will be linked to Charter's continuous quality improvement efforts and to its new Clinical Outcome Monitoring System.

This study examines staffing patterns, lengths of stay, and utilization rates in medical school-based psychiatric hospital treatment of children and adolescents. Results of surveys taken in 1984 and 1988 show that lengths of stay decreased during these four years, but utilization rates and number of beds tended to remain the same or increase. As economic pressures force hospitals to consider reducing staff, it is important to establish baseline data to evaluate and plan staffing patterns for child and adolescent inpatient units.

National developments suggest that the Mental Health Statistics Improvement Program (MHSIP) offers a suitable philosophical framework as well as standards for a minimum core of mental health data for the total field. With an emphasis on agency-level development and use of data systems, MHSIP could further management objectives in both the public and private sectors. Performance indicators derived from the MHSIP content could be the vehicle for the transformation of automated reams of data into a meaningful and useful consolidated management tool, a tool that would also further quality of care. This article briefly describes the background and content of the MHSIP and the type of performance indicators that can be derived from it and used by management.

The importance of outcome research in the field of children's mental health treatment has increased in recent years because of enhanced consumer awareness, a decrease in available resources, and payers' demand for accountability. The present study evaluated the treatment program of a child psychiatric unit in a public university hospital in the southeastern United States. The research used a single-group, pre- and post-test design and the Child Behavior Checklist (CBCL) as the outcome measure. Children receiving inpatient psychiatric treatment demonstrated statistically significant improvements in CBCL scores. The strengths and limitations of this study are discussed.

Private psychiatric hospitals are acquiring information systems to provide timely and accurate data for improved patient care and financial operations. Serious commitment of staff time, effort, and financial resources is required during the selection and management of the system to achieve full benefits from this technology. Active participation by senior management and the end-user community in the planning and acquisition process will lay the foundation for a successful system implementation.

Changes in clinical management and reimbursement approaches have placed new pressures on psychiatric hospitals to have immediate access to critical information. Information systems management is in the difficult position of responding--while under this pressure--to a host of requests for computer applications that may be at cross purposes with each other. Pine Rest Christian Hospital, a full-continuum, 146-bed, not-for-profit psychiatric facility in Grand Rapids, Michigan, has been preparing tactics to deal with information systems management under pressure. This paper describes the consequent information systems management approaches and some of the critical computer applications Pine Rest has installed.

The past decade has brought extraordinarily rapid changes to the treatment of patients with severe mental illnesses. Changes evolved from advances in technologic and pharmacologic understanding as well as from complex fiscal and political pressures. Increasingly, regimented standardization in approach narrows the range of treatment options. Both within and outside of psychiatry, some disparage psychodynamic approaches. Psychiatrists are required to accept as plausible standardized and constricted time frames for evaluation and treatment. Thus we are asked to view the mind's storms as strictly neuronally based and to view our patients as passively compliant. By implication, treatment alliance is to be cemented by a prescription and authority. This paper presents clinical material drawn from hospital-based experience at The Chestnut Lodge Hospital, Rockville, Maryland, meant to place current trends in an historic context. The author offers possible alternatives to resignation in the face of current pressures.

Executive managers can ensure the most efficient management of the physical assets of their psychiatric hospital by involving the facility management staff in all phases of all planning and implementation. This paper stresses how maintaining expert in-house staff and equipping them with comprehensive computer-based tools results in the efficient use of available space and in good management of both capital and operating expenses. As the hospital liaison with outside design firms and regulatory agencies, the facility management staff can effectively communicate the facility's requirements and represent its interests.

The potential role of partial-hospital programs in solving both clinical and fiscal problems is acknowledged. The development of one partial-hospital program in the context of an inpatient-oriented hospital is reviewed in some detail. Lessons learned are identified, and anticipatory strategies are noted to facilitate the development of new programs should the funding become available.

Widespread changes in the criteria and resources for psychiatric inpatient treatment of adolescents present enormous challenges and demand serious and far-reaching adaptive efforts. Among these efforts may be a redesigning of the inpatient treatment milieu to accommodate different patient populations for whom different models of treatment and therapeutic strategies are necessary. This paper describes the redesigning and successful integration of an adolescent inpatient unit at a private psychiatric hospital to include separate treatment tracks for three different patient populations. An intensive/reconstructive treatment track provides the long-term inpatient treatment of youth with treatment-refractory personality disorders who have the clinical justification and resources for therapy that aspires to effect structural personality change. An acute crisis intervention track provides short-term inpatient treatment with an adaptation-oriented and highly focused approach to patients who have had limited previous treatment, are confined to short lengths of stay by financial constraints, or for whom regression should be discouraged. Finally, a psychosocial skills treatment group conducts longer term inpatient treatment for neurobiologically impaired patients. Psychotic, severely developmentally disturbed, profoundly abused patients, and those with extremely primitive personalities characterized by an abundance of deficits cannot tolerate the emotional and interpersonal intensity of a reconstructive treatment approach, but can benefit from a supportive, developmental, ego-building strategy.