Patient Requests for Discharge from Voluntary Psychiatric Hospitalization: a Chart Review

• Published in: Psychiatric quarterly 2019-12, Vol.90 (4), p.849-859
• Main Authors: Garakani, Amir, Appel, Jacob M., Aloysi, Amy S., Martinez, Jose M., Larkin, Kaitlyn, Buono, Frank D.
• Format: Article
• Language: English
• Subjects: Chart reviews; Clinical outcomes; Confirmatory factor analysis; Early discharge; Employment; Factor analysis; Health care expenditures; Hospitalization; Inpatient care; Medicine; Medicine & Public Health; Mental disorders; Original Paper; Patient admissions; Psychiatric hospitals; Psychiatry; Public Health; Recurrent; Regression analysis; Sociology; Suicidal ideation; Suicide; Tobacco; Toxicology; Unemployment; Urine; Voluntary
• ISSN: 0033-2720; 1573-6709
• DOI: 10.1007/s11126-019-09671-y

The purpose of this study was to examine the rate of 72-hour letters (written requests for discharge, with 72 hours indicating the time the hospital has to discharge or seek retention) placed by voluntary psychiatric inpatients at a New York City hospital and determine whether there are factors contributing to the rates of discharge requests. Charts from all voluntary psychiatric hospitalizations during the calendar year 2007 were retrospectively reviewed. Included were all single voluntary admissions by adults (age 18 years and older) to the hospital. A confirmatory factor analysis (CFA) was conducted with the following factors: urine toxicology, cigarette use on admission, suicidal ideation upon presentation, employment, past inpatient psychiatric admission, and admission day. A linear regression was used to evaluate the relationship between discharge requests and these factors. Of the total sample ( N  = 581), 119 (20.5%) patients submitted 72-hour letters. The stepwise linear regression analysis confirmed a positive relationship between letter placement and admission day (M = 3.5, SD = 1.7), unemployment (M = 4.7, SD = 2.1), suicidal ideation (M = .5, SD = .5), positive urine toxicology (M = .47, SD = .5), previous psychiatric hospitalization (M = .7, SD = .5) and cigarette usage (M = .5, SD.5) R 2  = .043, (6, 461) = 3.42, p  = .003). These specific variables accounted for 55.6% of likelihood of a patient submitting a 72-hour letter. Several factors, related to substance and tobacco use, employment, and recurrent use of inpatient services, likely contribute to requests for early discharge. Addressing these factors may help improve inpatient care, reduce costs and improve patient outcomes in the long term.