Clinical factors related to and predictive of psychiatric inpatient length of stay
Over the past 20 years, length of stay for psychiatric hospitalization has steadily decreased. The current research examined predictors of length of stay, in particular the impact of patient-reported symptom severity at admission and rate of participation in group psychotherapy, in addition to source of payment for hospitalization. Additionally, this research examined impact of length of stay on clinically significant improvement while hospitalized and on post-discharge functioning. The sample was comprised of 163 adult women ages 18 to 62 hospitalized on an acute stabilization unit with a Cognitive Behavioral Therapy (CBT) milieu and group psychotherapy program. Participants completed self-report measures of psychosocial functioning and mood symptoms at admission, discharge, and one and three months post-discharge. Length of stay ranged from 3 to 58 days (mean = 11.12, SD = 8.03), and 82.2% of the sample stayed for two weeks or less. Regression analyses revealed that type of financial coverage, readiness for change (URICA score), and level of depression at admission (BDI-II) significantly contributed to predicting length of stay. No other clinical predictors, including rate of group participation, significantly added to the model after controlling for payment source and readiness for change. In addition, results indicated that patients can make clinically significant improvement while briefly hospitalized, although mean length of stay could not be considered statistically equivalent between those who did and did not make clinically significant improvement. Overall, this research did not find a significant relationship between length of stay and poor outcomes after discharge. Thus, these results lend support to the growing body of research that the steady decline in length of inpatient psychiatric hospitalization has not had an overly adverse impact for patients. In addition, these results suggest that length of stay is a complex variable with multiple determinants and it may be more useful to focus more on the level of improvement rather than the number of days in the hospital when rendering discharge decisions.
Berry, Courtney C, "Clinical factors related to and predictive of psychiatric inpatient length of stay" (2011). ETD Collection for Fordham University. AAI3495881.