UVM Theses and Dissertations
Format:
Print
Author:
Johnston, Alexander
Dept./Program:
Nursing
Year:
2014
Degree:
MS
Abstract:
Background: Inpatient psychiatric length-of-stay has decreased in the past 40 years. Previously valued as a therapeutic intervention, the concept ofthe milieu has been deemphasized during this period. Studies associate perception of milieu with treatment outcome, but literature is scant on specific independent variables of milieu in psychiatric treatment outcome.
Objective: This study investigated the number of emergency events as a proxy for aggression, control and disorder on a psychiatric milieu. These events were analyzed as an independent variable in psychiatric peer outcomes, the dependent variable. Outcomes were measured by length-of-stay, and global-assessment-of-function scores.
Methods: This three-year, retrospective, cohort design used data from hospital electronic medical record datab~ses to analyze the independent variables impact on dependent variable outcomes. The study evaluated data from two cohorts on one inpatient unit that experienced a change in patient population after a regional reduction in psychiatric beds, resulting in increased unit emergency events. Correlations, comparison of means, and regression analyses ofthe independent variables and dependent outcomes from the two cohorts provided data for discussion.
Results: The total sample in the study included 778 unique hospital visits. After exclusion criteria were applied, 610 visits were analyzed. Statistical analysis identified significant differences between groups. The latter group was 9% younger (3.76 years), increased male by percentage (49.9% vs. 67.2%), had a patient population with an 11 % increased diagnoses of psychosis, 3% increased diagnosis of mania, and a 12% decrease in diagnoses of depression. Additionally, those males who were depressed had 23% lower global-assessment-of-function scores on admission ( -4.47 points). Mean number of emergency events experienced by patients in the latter group increased 619% (0.16 to 0.99 events per day). Male patients with psychosis had a 39% increase in length-of-stay (+5.82 days). Length-of-stay was not significantly different for other diagnostic codes. Regression analysis shows that emergency events on the unit were a significant predictor of the variance in length-of-stay for male patients with psychosis.
Conclusion: Milieu variables have an impact on psychiatric hospitalizations. Data supports the conclusion that increased unit aggression increases length-of-stay for male patients with psychosis on this unit. Potentially, these findings could impact policy associated with duration of untreated psychosis, enhance education to providers about the differing responses to hospitalization by diagnosis, and affect milieu practices that support coping with hospitalization. This sample provided statistically significant results. Further research should be conducted with diverse inpatient settings to improve generalizability, and to increase statistical power in subgroup analysis.
Objective: This study investigated the number of emergency events as a proxy for aggression, control and disorder on a psychiatric milieu. These events were analyzed as an independent variable in psychiatric peer outcomes, the dependent variable. Outcomes were measured by length-of-stay, and global-assessment-of-function scores.
Methods: This three-year, retrospective, cohort design used data from hospital electronic medical record datab~ses to analyze the independent variables impact on dependent variable outcomes. The study evaluated data from two cohorts on one inpatient unit that experienced a change in patient population after a regional reduction in psychiatric beds, resulting in increased unit emergency events. Correlations, comparison of means, and regression analyses ofthe independent variables and dependent outcomes from the two cohorts provided data for discussion.
Results: The total sample in the study included 778 unique hospital visits. After exclusion criteria were applied, 610 visits were analyzed. Statistical analysis identified significant differences between groups. The latter group was 9% younger (3.76 years), increased male by percentage (49.9% vs. 67.2%), had a patient population with an 11 % increased diagnoses of psychosis, 3% increased diagnosis of mania, and a 12% decrease in diagnoses of depression. Additionally, those males who were depressed had 23% lower global-assessment-of-function scores on admission ( -4.47 points). Mean number of emergency events experienced by patients in the latter group increased 619% (0.16 to 0.99 events per day). Male patients with psychosis had a 39% increase in length-of-stay (+5.82 days). Length-of-stay was not significantly different for other diagnostic codes. Regression analysis shows that emergency events on the unit were a significant predictor of the variance in length-of-stay for male patients with psychosis.
Conclusion: Milieu variables have an impact on psychiatric hospitalizations. Data supports the conclusion that increased unit aggression increases length-of-stay for male patients with psychosis on this unit. Potentially, these findings could impact policy associated with duration of untreated psychosis, enhance education to providers about the differing responses to hospitalization by diagnosis, and affect milieu practices that support coping with hospitalization. This sample provided statistically significant results. Further research should be conducted with diverse inpatient settings to improve generalizability, and to increase statistical power in subgroup analysis.