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Short-stay crisis units for mental health patients on crisis care pathways: systematic review and meta-analysis.
Anderson, Katie; Goldsmith, Lucy P; Lomani, Jo; Ali, Zena; Clarke, Geraldine; Crowe, Chloe; Jarman, Heather; Johnson, Sonia; McDaid, David; Pariza, Paris; Park, A-La; Smith, Jared A; Stovold, Elizabeth; Turner, Kati; Gillard, Steve.
  • Anderson K; Division of Nursing, School of Health Sciences, City, University of London, UK.
  • Goldsmith LP; Division of Nursing, School of Health Sciences, City, University of London, UK.
  • Lomani J; Division of Nursing, School of Health Sciences, City, University of London, UK.
  • Ali Z; Library Services, St George's, University of London, UK.
  • Clarke G; Improvement Analytics Unit, The Health Foundation, UK.
  • Crowe C; Sunflowers Court, North East London NHS Foundation Trust, UK.
  • Jarman H; Emergency Care, St George's University Hospitals NHS Foundation Trust, London; and Population Health Research Institute, St George's, University of London, UK.
  • Johnson S; NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK.
  • McDaid D; Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK.
  • Pariza P; Collabor8research, London, UK; and Division of Nursing, School of Health Sciences, City, University of London, UK.
  • Park AL; Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK.
  • Smith JA; Population Health Research Institute, St George's, University of London, UK.
  • Stovold E; Population Health Research Institute, St George's, University of London, UK.
  • Turner K; Population Health Research Institute, St George's, University of London, UK.
  • Gillard S; Division of Nursing, School of Health Sciences, City, University of London, UK.
BJPsych Open ; 8(4): e144, 2022 Jul 25.
Article in English | MEDLINE | ID: covidwho-1962922
ABSTRACT

BACKGROUND:

Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units.

AIMS:

This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units.

METHOD:

We searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies - of Interventions and Risk of Bias in Randomized Trials.

RESULTS:

Data from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI -261.24 to -67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43-0.68; P < 0.001).

CONCLUSIONS:

Short-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Language: English Journal: BJPsych Open Year: 2022 Document Type: Article Affiliation country: Bjo.2022.534

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Language: English Journal: BJPsych Open Year: 2022 Document Type: Article Affiliation country: Bjo.2022.534