RESUMO
BACKGROUND: Inpatient treatment is not the most beneficial treatment setting for many patients with psychiatric disorders and overcrowding is a recurrent problem for psychiatric hospitals. Therefore, it is important to develop strategies to limit avoidable inpatient treatment. This study sought to evaluate the impact of an emergency hotline that was developed to better manage psychiatric patients, particularly for identifying those requiring a hospital admission. METHODS: This pre-post intervention quality improvement study compared changes in the management of psychiatric patients' admission before and after the introduction of an emergency hotline where a specialist in psychiatry examines all inpatient referral from private practitioners. Main outcomes were the change in proportion of hospital admissions after referral from a private practitioner before and within 3 months after the intervention. Secondary outcomes were the average length of hospital stay, proportion of non-voluntary admission, the time required for triage and the impact of the intervention on treatments' costs. Fisher's Exact test was used to test the primary hypothesis of difference in the proportion of hospitalized patients before and after introduction of the emergency hotline. Secondary outcomes were tested with Student's t-test for continuous variables and Fishers's Exact test for proportions. RESULTS: Among 45 admission requests from private practitioners during the 3 months after introduction of the new emergency hotline, 25 (55.6%) were accepted as inpatient treatment, while 20 (44%) were redirected to more appropriate outpatient treatments. There was a highly significant difference from the baseline period during which all 34 requests were accepted (44% vs 100%, p < 0.001). In addition, for the patients hospitalized after the introduction of the emergency hotline there was a trend-level reduction of the average length of stay (9.32 days vs 17.35 days). CONCLUSION: Implementation of an emergency hotline manage by a specialist in psychiatry for admissions to acute psychiatric wards is feasible and simple to use. Importantly, it allows to significantly decrease the proportion of hospitalizations. Additional studies are needed to assess the generalizability of these exploratory results to other health care settings.
Assuntos
Hospitalização , Linhas Diretas , Serviço Hospitalar de Emergência , Humanos , Suíça , Centros de Atenção TerciáriaRESUMO
The COVID-19 pandemic represents a major challenge for the general population. What about people already suffering from mental health problems? We describe the results of a regular survey conducted on patients undergoing treatment in an outpatient psychiatric clinic. The goal was to determine their experience of the first wave of the pandemic, its impact on the meaning of their lives and their spirituality and the types of support (medical and other) they receive. The results highlight that the role of outpatient treatment (sometimes the only assistance provided when containment measures are put in place) is important for a large number of patients. Overall, these data justify and inform the continuation of psychiatric and psychotherapeutic treatment during the pandemic period.
La pandémie de Covid-19 représente une adversité importante pour la population générale. Qu'en est-il pour les personnes déjà atteintes dans leur santé mentale ? Nous rapportons les résultats d'un questionnaire proposé systématiquement à des patients suivis dans une consultation psychiatrique. L'objectif était de déterminer le vécu des patients face à la première vague de la pandémie, l'impact de celle-ci sur le sens de leur vie et leur spiritualité, puis les moyens d'aide (médicale et autres) dont ils bénéficient. Les résultats soulignent que le rôle du suivi ambulatoire (parfois seul à se maintenir lorsque des mesures de confinement sont mises en place) est important pour un grand nombre de patients. Au total, ces données justifient et informent la poursuite de traitements psychiatriques et psychothérapeutiques en période de pandémie.
