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Length of Stay of General Psychiatric Inpatients in the United States: Systematic Review

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Abstract

Psychiatric length of stay (LOS) has reduced but is still longer than for physical disorders. Inpatient costs are 16% of total mental health spending. Regression analyses of the determinants of LOS for US adult psychiatric inpatients were systematically reviewed. Most studies predated recent LOS reductions. Psychosis, female gender and larger hospital size were associated with longer LOS, while discharge against medical advice, prospective payment, being married, being detained and either younger or middle age were associated with shorter LOS. Associations appeared consistent, especially where sample size was above 3,000. Updated studies should be adequately powered and include the variables above.

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Notes

  1. Eleven variables were measured in three analyses: doctors per capita, ECT and major procedures including ECT, employed, comorbid personality disorder, prior authorization/pre-admission screening, public ownership, region, seclusion and restraint, urban location, utilization review (excluding the effect of Medicaid utilization review on non-Medicaid patients in Frank and Lave 1986), and violence. 18 variables were measured in 2 analyses: active military duty, area wage index, death at discharge, divorced, expected gain for hospital from prospective payment, hospital with disproportionate low income patients, number of acute beds, partial hospitalisation program, proprietary ownership, psychiatric beds per capita, psychiatric emergency room, psychiatric longstay beds, psychiatric OPD, rural referral center, short-term beds per capita, sole community hospital, treating psychiatrist, years of education. 37 variables were measured in 1 analysis: admission via ER, attending is a psychiatrist, bed occupancy, change of diagnosis, dependents, disability benefits, discharge to daycare, discharge to private psychiatrist, discharged home, disease stage, doctors per bed, duration of symptoms, early readmission, family meeting held, family history of psychiatric illness, general hospital with alcohol unit, general hospital with psychiatric unit, homelessness, hospital, level of function scale, MMSE score, nurses per bed, paranoia, physical abuse, past psychiatric history, private attending psychiatrist, private ownership, separated, sexual abuse, specific drug treatment, suicidality, Trails A score, unit, violence with schizophrenia, voluntary ownership, VR score, widowed.

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Acknowledgments

Dr. Tulloch is supported by a UK Medical Research Council Special Research Training Fellowship in Health Services Research. The authors are grateful for the assistance of the many study authors who were contacted in relation to particular queries. Professor Steven Stern (University of Virginia) and Dr. Michael Compton (Emory University School of Medicine) generously provided additional data which were used in the analyses.

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  1. Department of Psychiatry, Institute of Psychiatry, Kings College London, De Crespigny Park, London, SE5 8AF, UK

    Alex D. Tulloch, Paul Fearon & Anthony S. David

  2. Trinity College Dublin and St Patrick’s University Hospital Dublin, James’s Street, Dublin 8, Ireland

    Paul Fearon

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  1. Alex D. Tulloch
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Correspondence to Alex D. Tulloch.

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Tulloch, A.D., Fearon, P. & David, A.S. Length of Stay of General Psychiatric Inpatients in the United States: Systematic Review. Adm Policy Ment Health 38, 155–168 (2011). https://doi.org/10.1007/s10488-010-0310-3

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