CRISIS HOSPITALIZATION ON A PSYCHIATRIC EMERGENCY SERVICE

The availability of short-stay beds for brief admissions to a Psychiatric Emergency Service (PES) is a model that meets a variety of patient and system needs, allowing time to develop alternatives to hospitalization or gain diagnostic clarity, serving a respite function, providing a hospital setting that does not gratify dependency needs, and relieving inpatient census pressures. An eight-bed service for brief inpatient stays of up to 3 days was developed on a PES which serves a large nine-country catchment area in northeastern New York State. Admissions to this unit would otherwise have gone to a medical school teaching hospital psychiatric unit or a state psychiatric center. Fifty-one consecutive admissions were studied. The majority of patients were dischargeable in the short time frame and did not require transfer for longer-term care. The patients as a group showed improvement in psychiatric symptomatology and rated high satisfaction with the program. Most patients were diagnosed with schizophrenia or personality disorder (PD). Suicidality and substance abuse were frequent. The PD patients had a strong association with suicidality and some association with substance abuse, whereas the schizophrenics had more psychiatric symptomatology. PD patients were more likely to be discharged, leading us to propose a rationale for why this group may be uniquely suited to this approach. The study was replicated after a year on another sample of 51 consecutive admissions, confirming the earlier results and providing a 1-year follow-up on the program. The admission rate to the program was up 24%, and more PD patients and fewer schizophrenics were treated. Representative patients who benefitted from the program were presented. A review of the treatment of two patients showed dramatic savings in utilization of inpatient resources.