The NHS Mental Health Implementation Plan aims to reduce length of inpatient psychiatric stays to a maximum of 32 days, yet provides little guidance on how to achieve this. Previous studies have attempted to analyse factors influencing length of stay in mental health units, focussing mostly on patient factors. These models fail to sufficiently explain the variation in duration of inpatient stay. We assess how the type of service delivered by a trust, in addition to patient factors, influences length of stay. We conducted a retrospective case cohort study in a large inner-city NHS mental health trust for all admissions in a 1 month period. Data was gathered from electronic notes of 105 patients. Descriptive univariate and bivariate analyses were conducted on the data, with multiple regression analysis conducted on statistically significant data. Short-stay assessment ward admission significantly reduced length of stay. Patients under outpatients or under care co-ordination, admitted through Mental Health Act assessment and formally detained all had longer length of stay. Out of area admissions, locum Consultant care, changing Responsible Clinician and ward transfers all led to longer length of stay. Factors indicating more severe illness such as increased observation level and polypharmacy, as well as diagnoses of psychosis or bipolar disorder were associated with longer duration of stay. Discharges requiring referral to accommodation or rehabilitation led to longer stays. The most significant factors that influenced length of stay were higher observation levels, diagnosis of psychotic illness or bipolar, and discharge to rehabilitation placement. The final model, taking into account all these factors, was able to account for 59.6% of the variability in length of stay. The study backs up existing literature which shows patient-factors have an influence on length of stay. The study also demonstrates that service-level factors have an impact on the duration of stay. This data may be used to inform further studies which may aid provision of inpatient and community services in the future.

中文翻译：

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影响急性心理健康服务住院时间的患者和服务水平因素：一项回顾性病例队列研究。

《 NHS心理健康实施计划》旨在将住院精神病患者的住院时间缩短至最多32天，但几乎没有提供有关如何实现这一目标的指导。先前的研究试图分析影响精神卫生部门住院时间的因素，主要集中在患者因素上。这些模型无法充分说明住院时间的变化。除了患者因素之外，我们还会评估信托提供的服务类型如何影响住院时间。我们在一个大型内城区NHS精神卫生信托基金中对1个月内的所有入院者进行了回顾性病例队列研究。数据收集自105例患者的电子笔记。对数据进行描述性单变量和双变量分析，对统计显着性数据进行多元回归分析。短期住院病房大大缩短了住院时间。在门诊或护理协调下，通过《心理健康法》评估入院并被正式拘留的患者的住院时间更长。外地住院，临时顾问护理，不断变化的负责临床医生和病房转移都导致住院时间更长。指示更严重疾病的因素，例如增加的观察水平和多药店以及精神病或躁郁症的诊断与更长的住院时间相关。需要转诊住宿或康复的出院导致住院时间更长。影响住院时间的最重要因素是较高的观察水平，诊断为精神病或双相情感障碍以及出院到康复场所。最终模型 考虑到所有这些因素，能够占到住院时间变异性的59.6％。这项研究支持了现有的文献，这些文献表明患者因素对住院时间有影响。该研究还表明，服务水平因素会影响住院时间。该数据可用于为进一步的研究提供信息，以帮助将来提供住院和社区服务。