Factors Influencing on Length of Stay in a Psychiatric Open Ward of a General Hospital / 신경정신의학

OBJECTIVES: The cost of psychiatric service is increasing every year in Korea. The length of inpatient stay (LOS) is an important factor determining in-patient service cost. This study was aimed to find the factors that influence LOS in a psychiatric open ward of a general hospital. METHODS: The study includes 134 inpatients who were consecutively admitted to a psychiatric open ward in a general hospital from January 1st to June 30th in 2001. Demographic data, clinical characteristics on admission and discharge, global functioning, social support levels and life stressors were collected. RESULTS: The mean LOS for the 134 patients was 15.5 days (S.D 9.2). The occupation of housekeeper and those secred high in phobic anxiety subscale on SCL-90-R were statistically significant predictor for longer LOS in the univariate analysis. No significant differences in LOS were found by diagnostic groups and social support. In multiple regression analysis, the scores of phobic anxiety subscale, occupation and presence of physical illness were statistically significant predictor for LOS. CONCLUSION: This study failed to find the significant variables to account for substantial proportion of variance for LOS.

A Comparative Study on the Therapeutic Setting of the Open and the Closed Ward in Mental Hospital / 신경정신의학

OBJECTIVES: The treatment setting of mental hospital has a great influence on the outcome of treatment. The authors compared the characteristics of treatment setting of the open and the closed wards in a mental hospital and the attitudes of the staff and patients on each ward. METHODS: Total four wards two typical open wards and two typical closed wards were selected and each contained one male ward and one female ward. Ward Atmosphere Scale(WAS) was conducted to each and the mean scores of suscales of WAS were compared by using Student's t-test. RESULTS: 1) The closed ward was similar to the treatment setting of control-oriented program which stresses the stator control and the nile of ward and ignores the autonomy of patients and such a evaluation was perceived more by the patients than by the staff. 2) The open ward supported and encouraged the staff and patients and focused on solving the practical problems of the patients, and especially the staff perceived it as the treatment program the activated ward. 3) It was shown that the open ward was more therapeutic and while it focused on the autonomous problem solving, the closed ward pup enguasis on the protection of patients. In addition, the patients were more sensitive to the difference of setting between the two wards than the star. CONCLUSION: In conclusion, if various and realistic programs were offered to the patients in the ward, the open ward would be proposed as a desirable therapeutic form for the chronic psychiatric inpatients.

The Quality of Life and Perception on Ward Atmosphere in Chronic Schizophrenic Patients / 신경정신의학

OBJECTIVES: This study was designed to compare the ward atmosphere of an open ward and that of a closed ward as perceived by chronic schizophrenic patients, and to and out whether the perceived ward atmosphere is associated with their quality of life, and also to get some practical suggestions for treatment policies of open wards. METHODS: Fifty-two chronic schizophrenic inpatients were selected, 26 of them were in an open ward and the remaining 26 patients were in a closed ward, in Seoul National Mental Hospital. All the patients were asked to answer the whole items of Ward Atmosphere Scale (WAS) and SCL-90-R. Objective indicators and subjective indicators of their quality of life were scored during a face to face interview using portions of Lehman's Quality of Life Interview. The subjective indicators of quality of life were combined to a single 'global quality-of-life score' and then examined for associations with other variables. All the measures were compared between the two groups. Covariate adjustments were made as needed. RESULTS: The open ward patients reported significantly higher scores on 'support', 'autonomy' and 'practical orientation' subscales among WAS in comparison with closed ward patients. The open ward patients reported higher 'global quality-of-life score' compared with the closed ward patients. These differences were also significant following covariate adjustments for demographic, clinical and objective quality of life variables. Among the WAS subscales 'order and organization'(r=0.49, p <.05) was the highest correlate of 'globol quality-of-life score' in case of open ward patients, and 'support'(r=0.59, p<.01) was the highest correlate in case of closed ward patients. CONCLUSION: The open ward patients reported better satisfaction with life, and their reported satisfaction were associated with their higher ratings on WAS.