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Length of hospitalisation for people with severe mental illnessAlwan NA, Johnstone P, Zolese G
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Summary
Plain language summary The time spent in hospital for people with serious mental illness has declined in high income countries over the past 30 years due to changes in the health care policies; with more emphasis placed nowadays on community care. We reviewed the effects of planned short stay hospitalisation compared with standard length of hospitalisation for people with serious mental illnesses. We found no evidence to suggest that planned short-stay hospital admissions for people with severe mental illness encourages a revolving door pattern of admission or provides less optimal care to patients. More well-conducted randomised controlled trials would be very useful.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 26. 1999 AbstractBackgroundIn high income countries, over the last three decades, the length of hospital stays for people with serious mental illness has reduced drastically. Some argue that this reduction has led to revolving door admissions and worsening mental health outcomes despite apparent cost savings, whilst others suggest longer stays may be more harmful by institutionalising people to hospital care. ObjectivesTo determine the clinical and service outcomes of planned short stay admission policies versus a long or standard stay for people with serious mental illnesses. Search strategyWe searched the Cochrane Schizophrenia Group's register of trials (July 2007). Selection criteriaWe included all randomised trials comparing planned short with long/standard hospital stays for people with serious mental illnesses. Data collection and analysisWe extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated fixed effects weighted mean differences (WMD). Main resultsWe included six relevant trials. We found no significant difference in hospital readmissions between planned short stays and standard care at one year (n=651, 4 RCTs, RR 1.26 CI 1.0 to 1.6). Short hospital stay did not confer any benefit in terms of 'loss to follow up compared with standard care (n=453, 3 RCTs, RR 0.87 CI 0.7 to 1.1). There were no significant differences for the outcome of 'leaving hospital prematurely' (n=229, 2 RCTs, RR 0.77 CI 0.3 to 1.8). More post-discharge day care was given to participants in the short stay group (n=247, 1 RCT, RR 4.52 CI 2.7 to 7.5, NNH 3 CI 2 to 6) and people from the short stay groups were more likely to be employed at two years (n=330, 2 RCTs, RR 0.61 CI 0.5 to 0.8, NNT 5 CI 4 to 8). Economic data were few but, once discharged, costs may be more for those allocated to an initial short stay. Authors' conclusionsThe effects of hospital care and the length of stay is important for mental health policy. We found limited data, although outcomes do suggest that a planned short stay policy does not encourage a 'revolving door' pattern of admission and disjointed care for people with serious mental illness. More large, well-designed and reported trials are justified. |