PHILADELPHIA – Switching physician coverage in a hospital’s acute-care psychiatric ward from 13 consultant psychiatrists to a single, full-time hospitalist psychiatrist led to significant care improvements and reduced costs.
Perhaps the most striking benefit from the staffing switch was in average patient length of stay, which dropped by about half, Dr. Julian Beezhold said at the meeting. Average length of stay fell from nearly 22 days before the staffing change to about 11 days. "The reduced length of stay made a huge impact on cost savings." In addition, "the evidence is overwhelming that patient outcomes were better" following the change, said Dr. Beezhold, chief of psychiatry at Norfolk and Waveney Mental Health in Norwich, U.K.
Mitchel L. Zoler/IMNG Medical Media
Dr. Julian Beezhold
Taking into account all the outcome changes produced by the switch to hospitalist-based psychiatric care, the study provides "overwhelming, robust evidence showing clear benefit from a hospitalist model of care," Dr. Beezhold concluded.
The Psychiatric Hospitalist Network Evaluation Study included 5,019 patients admitted to the hospital for an acute psychiatric condition in 2002-2010, during the 42 months before and 42 months after Norfolk and Waveney switched from relying on 13 consultant psychiatrists to having one hospitalist psychiatrist who either directly administered or supervised all psychiatric admissions and in-hospital management. As a control, the study used data collected from a second psychiatric ward at the hospital that treated similar patients from a different geographic region. The control ward remained on the hospitalist model for psychiatric care throughout the study period.
The patients averaged about 40 years old, and slightly more than half were men. The most common psychiatric diagnosis was psychosis, in a quarter to a third of the admitted patients, followed by bipolar disorder and depression.
To analyze outcomes, Dr. Beezhold and his associates compared outcome rates before and after the model change in the study ward, and compared the extent of change with what occurred in the control ward, which did not change its staffing model. For 15 of the 20 outcomes assessed, the test ward that switched from a consultant model to a hospitalist model had significantly better changes compared with the control ward.
The staffing change led to reductions in deaths, violent episodes, deliberate self-harm, staff accidents, and patient accidents, while the ward that had no change showed similar rates, smaller decreases, or even increases from the before to after periods. For example, the rate of all incidents per admission fell by a statistically significant 48% from the before to after period in the ward that switched to hospitalist care, which the same measure had a statistically not-significant, 4% rise from before to after in the control ward. The rate of deliberate self-harm per admission fell by a statistically significant 76% from before to after in the ward that switched to hospitalist care, while the same measure showed a statistically non-significant decline in the control ward.
The results are likely widely generalizable since they came from an observational study of routine, community practice that had no patient exclusions, Dr. Beezhold said.
Dr. Beezhold said he had no disclosures.