Variation in admission rates between psychiatrists on call in a university teaching hospital.

BACKGROUND: Hospital-based physicians must routinely decide whether patients receiving care in the emergency room require admission to an acute care bed. We endeavoured to understand clinician-related factors that influence the decision to admit. METHODS: We retrospectively examined data collected between August 1, 2013 and July 31, 2015 for patients triaged as mental health assessments in the emergency department of a university teaching hospital. We identified 1530 unique cases who had been reviewed by the staff psychiatrist for a decision on whether to admit to an acute care bed. Patient and physician characteristics were analyzed by standard descriptive methods, comparative statistics (Chi square and analysis of variance) and regression analyses using SPSS version 24.0 (IBM Corp. Armonk, NY, USA). RESULTS: There were no differences in patient characteristics in the clinical encounters reviewed by different staff psychiatrists. The physician factor found significant in deciding whether to admit the patient was assignment to PES (psychiatric emergency services). This appeared to be the only physician variable impacting the decision to admit a patient with PES psychiatrists admitting less often than their colleagues (p = 0.018, Table 3). The effect size of the variable in terms of odds ratio was 0.592. INTERPRETATION: Training and practice in emergency psychiatry lead to lower admission rates when these clinicians are on call. Training in emergency psychiatry for all psychiatrists participating in a call pool may result in lowered admission rates.

Predictors of readmission to a psychiatry inpatient unit.

OBJECTIVE: To determine predictors of time to readmission to a general psychiatry inpatient unit. METHOD: Data from the Minimum Data Set-Mental Health (MDS-MH), a standardized assessment used to collect demographic and clinical information, were retrospectively reviewed from April 2006 through October 2008. A total of 758 patients were eligible for the study. A set of clinically relevant predictors was generated based on a literature review. A Cox regression model was applied to determine which variables were most predictive of shorter time to readmission, and their respective hazard ratios (HR). RESULTS: Covariates that were significantly associated with readmission (HR [95% CI]) included receiving a pass (3.48 [2.33, 5.17], p ≤ 0.0005), 1-2 psychiatric admissions in the past two years (15.63 [7.50, 32.55], p ≤ 0.0005), and more than 3 psychiatric admissions in the past two years (24.15 [11.58, 50.36], p ≤ 0.0005). Post hoc analysis indicated that those issued passes were more commonly male (57.1% vs. 43.9%, p=0.03), with a longer length of stay (25.4 ± 21.2 days vs. 18.7 ± 21.1 days, p=0.008), and higher GAF score (62.8 ± 11.1 vs. 57.8 ± 13.9, p=0.003), but were otherwise similar. CONCLUSIONS: The factors that were associated with reduced time to readmission were a history of previous admissions and receipt of a pass prior to discharge. These results suggest that while physicians may be able to identify patients at high risk of early readmission, issuing a pass may not fully mitigate this risk. There is a need for critical research evaluating the potential benefits of passes.

Outcomes following appeal and reversal of civil commitment.

OBJECTIVE: Psychiatric inpatients may be detained against their will, yet they still retain the right to apply for a hearing to challenge this detention. We tested whether adjudicated decisions over whether to uphold or rescind the detention have implications in subsequent patient morbidity. METHODS: Consecutive patients applying to the Consent and Capacity Board in Ontario between January 1, 2004, and March 31, 2007, were identified who had a hearing to challenge their involuntary detention. Population based databases provided information on subsequent deaths, hospitalization for a psychiatric illness, or emergency department visit for any reason. RESULTS: A total of 3498 decisions were rendered for 2321 unique psychiatric patients during the 39 month study period. Almost all patients (90%) had a prior psychiatric admission. Approximately 18% of involuntary detentions were rescinded with subsequent outcomes showing a greater likelihood of emergency department visits within 100 days of discharge in the group whose detention was rescinded compared to the group whose detention was upheld (46% vs. 36%, P=.003). CONCLUSIONS: When an involuntary detention is rescinded patients have a high likelihood of subsequent utilization of emergency department services for suicide related symptoms but no large increase in risk of dying.

Peer group mentoring of junior faculty.

OBJECTIVE: The purpose of this article is to document and evaluate the initiation of a mentoring model for junior faculty utilizing a peer group approach rather than the traditional dyadic model. METHODS: Junior faculty members in an academic department of psychiatry at Sunnybrook Hospital, University of Toronto, were invited to take part in a peer mentoring program involving evening meetings every 2 months over a 1-year period from 2004-2005. Of the 12 invitees, 10 agreed to participate in the program. The group participants developed the program agenda collectively. Learning objectives as well as a list of topics of interest were established at the inaugural meeting. A focus group was held at the end of 12 months to provide a descriptive, qualitative evaluation. The focus group leader prepared a report based on observations and notes taken during the focus group. RESULTS: The report prepared by the focus group leader identified six main themes that included: program development, knowledge gains, interpersonal gains, psychological/emotional gains, process of the program, and future directions. The overall response was clearly favorable with a unanimous decision to maintain the group and continue meeting into the next year. CONCLUSION: A peer group mentoring format for junior faculty in an academic department of psychiatry can be an effective model of mentoring.