BMJ 1999;318:1387-1390 ( 22 May )

Papers

Systematic review of the effectiveness of planned short hospital stays for mental health care

Paul Johnstone, consultant in public health medicine, ^a Gabriella Zolese, consultant psychiatrist. ^b

^a Berkshire Health Authority, Reading, Berkshire RG30 2BA, ^b Pathfinder Mental Health Services NHS Trust, London SW17 7DJ

Correspondence to: Dr Johnstone paul.johnstone{at}Exchange.berks-ha.anglox.nhs.uk

Objective: To determine the effectiveness of planned short hospital stays versus standard care for people with serious mental illness.
Design: Systematic review of all randomised controlled trials comparing planned short hospital stay versus long hospital stay or standard care for people with serious mental illness.
Subjects: Four trials enrolled 628 patients.
Main outcomes measures: Relapse; readmission; death (suicides and all causes); violent incidents (self, others, property); lost to follow up; premature discharge; delayed discharge; mental state (not improved); social functioning; patient satisfaction, quality of life, self esteem, and psychological wellbeing; family burden; imprisonment; employment status; independent living; total cost of care; and average length of hospital stay.
Results: Patients allocated to planned short hospital stays had no more readmissions (in four trials, odds ratio 0.93, 95% confidence interval 0.66 to 1.29 with no heterogeneity between trials), no more losses to follow up (in three trials of 404 patients, 1.09, 0.62 to 1.91 with no heterogeneity between trials), and more successful discharges on time (in three trials of 404 patients, 0.47, 0.27 to 0.85) than patients allocated long hospital stays or standard care. Some evidence showed that patients allocated planned short hospital stay were no more likely to leave hospital prematurely and had a greater chance of being employed than those allocated long hospital stay or standard care. Data on mental, social, and family outcomes could not be summated, and there were few or no data on patient satisfaction, deaths, violence, criminal behaviour, and costs.
Conclusion: The effectiveness of care in mental hospitals is important to patients, carers, and policy makers. Despite inadequacies in the data, this review suggests that planned short hospital stays do not encourage a "revolving door" pattern of care for people with serious mental illness and may be more effective than standard care. Further pragmatic trials are needed on the most effective organisation and delivery of care in mental hospitals.

Key messages The effectiveness of care in mental hospitals is important to patients, carers, and policymakers irrespective of the quality and quantity of community care and the provision of newer psychotic drugs Inpatient costs use around 80% of mental health resources, yet a longstanding record of poor or inadequate evidence on the organisation and delivery of hospital care was highlighted Despite this, planned short hospital stays seem to be as successful, or more so, than standard care: patients experienced no more readmissions and no more losses to follow up and were more likely to be discharged on time than those receiving standard care Further pragmatic trials are needed that focus on the most effective organisation and delivery of care in mental hospitals

---

© BMJ 1999
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Effectiveness of planned short hospital stays for mental health care

Spencer Eth, Paul Johnstone, and Gabriella Zolese
BMJ 1999 319: 711. [Extract] [Full Text]

On being scientific about organising care
BMJ 1999 318: 0. [Full Text] [PDF]

Short planned hospital stays are more effective for patients with mental illness
BMJ 1999 318: 0. [Full Text]

This article has been cited by other articles:

• Tyrer, P., Suryanarayan, G., Rao, B., Cicchetti, D., Fulop, N., Roberts, F., Slaughter, J. (2006). The bed requirement inventory: a simple measure to estimate the need for a psychiatric bed.. International Journal of Social Psychiatry 52: 267-277 [Abstract]  
• Thornicroft, G., Tansella, M. (2004). Components of a modern mental health service: a pragmatic balance of community and hospital care: Overview of systematic evidence. Br. J. Psychiatry 185: 283-290 [Abstract] [Full text]  
• Hopko, D. R., Lachar, D., Bailley, S. E., Varner, R. V. (2001). Assessing Predictive Factors for Extended Hospitalization at Acute Psychiatric Admission. Psychiatr. Serv. 52: 1367-1373 [Abstract] [Full text]  
• SIPOS, A., HARRISON, G., GUNNELL, D., AMIN, S., SINGH, S. P. (2001). Patterns and predictors of hospitalisation in first-episode psychosis: Prospective cohort study. Br. J. Psychiatry 178: 518-523 [Abstract] [Full text]  
• Wesson, M., Walmsley, P. (2001). Service innovations: Sherbrook partial hospitalisation unit. Psychiatr. Bull. 25: 56-58 [Abstract] [Full text]  
• (2000). Other articles noted. Evid. Based Nurs. 3: 106-112 [Full text]  
• Eth, S., Johnstone, P., Zolese, G. (1999). Effectiveness of planned short hospital stays for mental health care. BMJ 319: 711b-711 [Full text]  

Rapid Responses:

Read all Rapid Responses

Poor editorial standards

Chris Hawley
bmj.com, 3 Jun 1999 [Full text]

Systematic review of out-dated studies

Spencer Eth
bmj.com, 9 Jun 1999 [Full text]