Community hospitals care for psychiatric patients in medical-surgical beds when psychiatric units are full
Many patients with psychiatric disorders requiring inpatient care are treated in community hospitals. Such patients may be admitted to psychiatric units or placed in general medical beds called "scatter beds." A new study found that nearly 7 percent of psychiatric discharges were from scatter beds, which community hospitals typically used as a short-term substitute for specialty psychiatric beds when units were full. Information was obtained on hospital discharges from 12 States for patients with a psychiatric diagnosis. A total of 370,984 patients (93.2 percent) were treated in community hospital psychiatric units. This group was compared with 26,969 patients (6.8 percent) who were treated in scatter beds.
Patients who were admitted to a scatter bed were more likely to be older and on Medicare when compared with patients admitted to a psychiatric unit. In addition, they were more likely to be admitted from the hospital's emergency department, have a shorter length of stay, and be later transferred to another facility. Only 35 to 43 percent of these patients had diagnoses of schizophrenia, mood disorders, or depression. Instead, they were more likely to be diagnosed with anxiety, dissociative (formerly multiple personality) disorder, and somatoform (formerly psychosomatic) disorders. Using scatter beds may be an appropriate response to a lack of psychiatric beds, particularly in rural areas, note the researchers. However, they point to several issues that must be addressed when using scatter beds.
These include the need for adequate staff training, the availability of consulting psychiatrists, and the ability to coordinate care with other psychiatric and behavioral providers in the region. Community hospitals also need more defined policies, procedures, and treatment strategies to ensure that patients receive the appropriate psychiatric care they need. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00009).
See "Psychiatric discharges in community hospitals with and without psychiatric units: How many and for whom?," by Tami L. Mark, Ph.D., M.B.A., Rita Vandivort-Warren, M.S.W., Pamela L. Owens, Ph.D., and others in the June 2010 Psychiatric Services 61(6), pp. 562-568.
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