Reducing Length of Acute Inpatient Hospitalization Using a Residential Step Down Model for Patients with Serious Mental Illness.
Psychiatric inpatient bed numbers have been markedly reduced in recent decades often resulting in long emergency department wait times for acutely ill psychiatric patients. The authors describe a model utilizing short-term residential treatment to substitute for acute inpatient care when the barrier to discharge for patients with serious mental illness (SMI) is finding appropriate community placement. Thirty-eight patients (community hospital (n = 30) and a state hospital (n = 8)) were included. Clinical variables, pre-/post-step down length of stay, and adverse outcomes are reported. Thirty of the 38 patients completed treatment on the residential unit and were discharged to the community. Five of the patients required readmission to an inpatient unit and the other three had pre-planned state hospital discharges. The majority of patients with SMI awaiting placement can be stepped down to residential treatment, potentially freeing up an inpatient bed for an acutely ill patient. Reforms in healthcare funding are necessary to incentivize such an approach on a larger scale, despite likely cost savings.
['Zarzar|Theodore|T|0000-0002-8562-3359', 'Sheitman|Brian|B|', 'Cook|Alan|A|', 'Robbins|Brian|B|']
D000328:Adult D005260:Female D006760:Hospitalization D006801:Humans D007902:Length of Stay D008297:Male D001523:Mental Disorders D012114:Residential Treatment D016896:Treatment Outcome
Step down Residential treatment Serious mental illness (SMI) State hospitals Length of stay