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Archives of Psychiatric Nursing

Volume 43, April 2023, Pages 106-110
Archives of Psychiatric Nursing

Factors influencing length of hospital stay among veterans admitted to an inpatient psychiatric unit☆

https://doi.org/10.1016/j.apnu.2022.12.001Get rights and content

Highlights

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    Hospitalization is appropriate for acute stabilization, prolonged stays can contribute to reduced quality of life, increased healthcare expenditures, and trauma exposure with associated trauma-related symptoms.

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    There are significant differences in the average length of stay between Veterans with substance use disorders and those with psychotic disorders (B=.576, p<.001)

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    Veterans with neurocognitive disorders also had longer lengths of stay than those without neurocognitive disorders, respectively (B=.014, p<.001).

Abstract

It is well established that Veterans are at increased risk for mental health problems and associated hospitalization. While hospitalization is appropriate for acute stabilization, prolonged stays can contribute to reduced quality of life, increased healthcare expenditures, and trauma exposure with associated trauma-related symptoms. To reduce inpatient psychiatric length of stay and to improve patient outcomes, it is imperative that risk factors for prolonged length of stay are elucidated. The purpose of this retrospective chart review was to examine demographic and clinical characteristics and their association with inpatient psychiatric length of stay in a sample of Veterans. Demographic information collected included age and race. Clinical characteristics collected included primary admitting psychiatric diagnosis, number of psychiatric emergencies during hospitalization, utilization of restraint or seclusion, observation status, 30-day readmission status, adherence to psychiatric follow-up appointments post-discharge, and presence of suicidality. A total of 820 Veterans were included in the analysis. Age, primary psychiatric diagnosis, occurrence of a psychiatric emergency, and observation status were significant predictors of length of stay (F = 24.39, p < .001). There were significant differences in the average length of stay between Veterans with substance use disorders and those with psychotic disorders (B = 0.576, p < .001). Likewise, Veterans with neurocognitive disorders also had longer lengths of stay than those without neurocognitive disorders, respectively (B = 0.014, p < .001). In summary, quality of mental health care can be improved by reducing length of stay, but additional understanding related to risk factors is first needed.

Section snippets

Background

In the United States, the majority of individuals with psychiatric disorders remain untreated (Rubio & Correll, 2017). Among them, Veterans are a particularly vulnerable group. It is well established that Veterans represent an underserved population, with higher rates of mental health problems (Liu et al., 2019), substance use disorders (Rhee & Rosenheck, 2019), homelessness (Evans et al., 2019), and suicidality (Bahraini et al., 2020) compared with their non-Veteran peers. Further, Veterans

Design and sample

This project employed a retrospective, observational design. Patient charts were reviewed for all Veterans admitted for inpatient psychiatric treatment in a 78-bed behavioral health department. The facility provides integrated behavioral health care spanning three states and accepts all Veterans over the age of 18 years, regardless of diagnosis. All unique Veterans admitted between April 1, 2020, and April 15, 2021, were included in the analysis.

Procedure

All data were collected directly from the

Results

Table 1 displays details related to demographic data. The majority of Veterans were Caucasian (n = 646, 78.8 %) and the average age of Veterans was 52.13 years (SD = 15.87). The most common diagnoses were depressive disorders (n = 199, 24.27 %), followed by bipolar disorders (n = 143, 17.44 %), psychotic disorders (n = 136, 16.59 %), and substance use disorders (n = 126, 15.37 %). Very few Veterans experienced a psychiatric emergency while hospitalized (n = 47, 5.73 %) and even fewer were

Discussion

The age of the Veterans was found to be a major predictor of length of stay, as reported in a previous study that analyzed lengths of stay in adult patients with psychotic disorders (Bessaha et al., 2017). The reported findings are similar to those previous related to increased length of stay in those with psychotic disorders (Crossley & Sweeney, 2020; Gosek et al., 2021; Silva et al., 2020), and also were congruent with previous work that those with substance use disorders were hospitalized

Conclusions

Prolonged length of stay is associated with adverse health outcomes and reduced quality of life, in addition to reduced productivity. Factors that contribute to longer lengths of stay in inpatient psychiatric units must be better understood so that targeted interventions can be developed for those at risk for prolonged lengths of stay. Because risk factors for a prolonged length of stay may be different among Veterans based on availability of Veterans Health Administration services, additional

Declaration of competing interest

The authors have no conflicts of interest to report.

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This work has not received funding, nor has it been submitted elsewhere.

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