Demonstrating the impact and model of care of a Statewide psychiatric intensive care service

• Published in: Australasian psychiatry : bulletin of the Royal Australian and New Zealand College of Psychiatrists 2013-10, Vol.21 (5), p.466-471
• Main Authors: Lee, Stuart, Hollander, Yitzchak, Scarff, Lisa, Dube, Ryan, Keppich-Arnold, Sandra, Stafrace, Simon
• Format: Article
• Language: English
• Subjects: Adult; Aggression; Antisocial Personality Disorder - epidemiology; Australia - epidemiology; Comorbidity; Female; Hospitalization; Humans; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Length of Stay; Male; Mental Disorders - epidemiology; Mental Health Services - organization & administration; Mental Health Services - statistics & numerical data; Outcome Assessment (Health Care); Substance-Related Disorders - epidemiology; Victoria - epidemiology
• ISSN: 1039-8562; 1440-1665
• DOI: 10.1177/1039856213497525

Objective: To characterise patients and their outcomes following referral to a Statewide psychiatric intensive care service. Method: This study conducted a medical audit for patients referred to the Statewide service during the first four years of operation (2007−2011). Demographics and the presence of alcohol and other drug and forensic comorbidities were documented along with the treatment received prior to and during admission. Results: In the first four years of operation, 58 referrals were received, 41 resulting in admission and seven in secondary consultation delivered to the referring inpatient psychiatry service. Admitted patients were most commonly experiencing a psychotic illness, had high levels of substance comorbidities and antisocial personality traits, required lengthy admissions (mean days = 41.5), and were in most cases successfully discharged back to the referring inpatient psychiatry service or the community. Significant reductions in clinician-rated difficulties measured via the Health of the Nations Outcome Scale were found at discharge, and despite the significant presenting aggression risk, few attempted or actual assaults occurred. Conclusion: Improved outcomes were achieved with patients deemed unsafe for psychiatric care in high dependency units in other Victorian acute mental health services through management by an acute service that has developed special expertise in this area.