evidence ethical evaluation and social consciousness along with competence and accessibility will be contnibuting to a healthier future for our patients. GAn. W. SmART,
PH.D.,
Use
of Acute
Care
R.N.C.S.
Beds
To the Editor: Beds intended for acute care patients in psychiatric inpatient facilities are frequently blocked by patients who lack access to community resources but require
no further inpatient We examined the
treatment (1). extent of this
phenomenon in a psychiatric hospital that provides a broad range of services to a largely rural population of600,000 in a 1 70,000-square-mile catchment area in the northeastern area ofthe Canadian province of Ontario. The hospital has 309 beds, of which 52 are located on an acute care inpatient service for adults. Admission and discharge data from 1987 through 1989 were cxamined to determine the duration of each patient’s hospitalization in the acute care program. Given the program’s clinical mandate of providing inpatient care for periods ofup to six weeks, we identified nonacute stays as those exceeding 42 days. Our analysis therefore subtracted 42 days from the length ofeach patient’s hospitalization to determine the number ofdays representing consumption of resources by nonacute patients. A total of 18,980 bed-days (365 days multiplied by 52 bcds)were available in the acute services program each year.
Our
analysis
showed
that
non-
acute care accounted for 18. 1 percent ofthc total annual bed days in 1987, 20 percent in 1988, and 19.8 percent in
1989.
Thus
in
each
of the
and Community
care beds
available
to the
catchment area. Second, a functional reduction in acute cane beds without an associated decline in demand for service places pressure on staifto discharge recovering patients prematurety so that beds can be offered to incoming patients. Third, the chronically debilitated patients who remain on acute care wards for extended periods (1-5) can be expected to consume a disproportionate share of nursing staff time because they frequently require cxtensive assistance in such areas as maintaining personal hygiene and feeding. Nursing staff arc therefore potentially less available to more acutely ill patients. Fourth, the extended presence of chronically debilitated patients on acute care wards conveys an imppropniate message to acutely ill patients. The ward milieu may inadvertently present a picture of chronicity and tong-term dependence on the hospital. Such a milieu is at cross purposes with the treatment needs of acutely ill patients, in whom staff hope to instill an attitude of optimism and belief in their ability to function independently. The seriousness of the implications of use of acute cane beds by nonacute patients indicates that furthen research on this issue is warranted. PAuL JAMES
DAN
R.
KING,
L.
DuFFY,
PESSOTFO,
Dr. King is chiefpsychologist at North Bay Psychiatric Hospital in North Bay, Ontario. Dr. Duffy is a psychiatrist in private practice in Richmond, British Columbia. Mr. Pessotto is a medicalstudent at the University of Toronto.
Psychiatry
1. Bigelow DA, Characteristics
Cutler DL, Moore of state hospital
who are hard to place. munity
Psychiatry
Hospitaland
39:181-185,
U, et al: patients
Corn1988
GellerJL, Costello DJ, et a!: Projecting inpatient admissions to state facilities in the 1990s. Hospital and Community Psychiatry 40:747-749, 1989
3. Mezzich
WH,
JE,
Coffman
fluencing length and Community
1264,
November
1270,
GE:
ofhospita!
Factors instay. Hospital
Psychiatry
36:1 263-
1985
1992
Vol. 43
No.
11
J:
B, Rochon
stay units, Canadianjournal
and
Length
of stay,
enrgency
short
admissions.
ofPsychiatry
34:39-42,
1989 5. Caton
M, Gralnick A: A review of issurrounding length of hospitalizaHospital and Community Psychiatry 38:858-863, 1987
sues tion.
DSM-IV
in Progress
(Continuedfrompage
1076)
1401-1405,
1980
2.
PurtellJJ, vations JAMA
3.
MJ, Guze SB: Hysteria: stability and usefulness ofclinical na: a quantitative study based on low-up period ofsix to eight years patients. New England Journal of icine 266:421-426, 1962
4.
Robins on clinical 146:901-909,
E, Cohen aspects
ME: Obserof hysteria.
1951
Perley
Feighner
JP,
Robins
Diagnostic criteria research. Archives 26:57-63, 1972
the cnitea folin 39 Med-
E, Guze SB, en a!: fur use in psychiatric ofGenera! Psychiatry
AJ: Somatoform disorders, in Comprehensive Textbook of Psychiatry, 5th ed, vol 1. Edited by Kaplan HI, Sadock BJ. Baltimore, Williams & Wilkins, 1989
5. Barsky
6. Qoninger
Somatoform and disin The Medical Basis of Psychiatry. Edited by Winokur G, Clayton P. Philadelphia, Saunders, 1986
7.
CR:
sociative
disorders,
Cloninger
CR,
Martin
a!: A prospective study
RI,
follow-up
of somatization in American Journal
men.
143:873-878,
Guze
SB, et family men and woof Psychiatry
and
1986
8. Robins LN, HelzerJE, Weissman MM, et a!: Lifetime prevalence ofspecific psychiatric disorders in three sites. Archives ofGeneral
9.
10.
References
2. Fisher
4. Baker
PH.D. M.D. B.Sc.
three
years studied, approximately onefifth ofthe hospital’s acute inpatient resources were utilized for purposes other than acute care. This serious erosion of acute care resources has at least four implications for the hospital studied. The first and most obvious is that the facility’s clinical program is compromised by the reduction in the num-
Hospital
ben ofacute
Psych
41:949-958,
1984
WOodrUff RA Jr. Clayton PJ, Gaze SB: Hysteria: studies of diagnosis, outcome, and prevalence. JAMA 215:425-428, 1971 Martin general
R: Somatoform disorders in the hospital setting, in Handbook of on General Hospital Psychiatry.
Studies Edited
byJudd
DR.
New York,
FK, BurrowsGD, Elsevier, 1991
Lipsitt
1 1. C!oninger CR, Yutzy SY: Somatofbrm and dissociative disorders: a summary of changes for DSM-W, in Current Psychi-
atnic
Therapy. Philadelphia,
Edited Saunders,
by Dunner in press
12. The KD-l0ClassificationofMenta! tions,
and
Disorders, Diagnostic
neva,
World
Health
Behavioral
Clinical
Organization,
DL.
and Descnip-
Guidelines.
Ge1992
1149
PH.D.,
Use
of Acute
Care
R.N.C.S.
Beds
To the Editor: Beds intended for acute care patients in psychiatric inpatient facilities are frequently blocked by patients who lack access to community resources but require
no further inpatient We examined the
treatment (1). extent of this
phenomenon in a psychiatric hospital that provides a broad range of services to a largely rural population of600,000 in a 1 70,000-square-mile catchment area in the northeastern area ofthe Canadian province of Ontario. The hospital has 309 beds, of which 52 are located on an acute care inpatient service for adults. Admission and discharge data from 1987 through 1989 were cxamined to determine the duration of each patient’s hospitalization in the acute care program. Given the program’s clinical mandate of providing inpatient care for periods ofup to six weeks, we identified nonacute stays as those exceeding 42 days. Our analysis therefore subtracted 42 days from the length ofeach patient’s hospitalization to determine the number ofdays representing consumption of resources by nonacute patients. A total of 18,980 bed-days (365 days multiplied by 52 bcds)were available in the acute services program each year.
Our
analysis
showed
that
non-
acute care accounted for 18. 1 percent ofthc total annual bed days in 1987, 20 percent in 1988, and 19.8 percent in
1989.
Thus
in
each
of the
and Community
care beds
available
to the
catchment area. Second, a functional reduction in acute cane beds without an associated decline in demand for service places pressure on staifto discharge recovering patients prematurety so that beds can be offered to incoming patients. Third, the chronically debilitated patients who remain on acute care wards for extended periods (1-5) can be expected to consume a disproportionate share of nursing staff time because they frequently require cxtensive assistance in such areas as maintaining personal hygiene and feeding. Nursing staff arc therefore potentially less available to more acutely ill patients. Fourth, the extended presence of chronically debilitated patients on acute care wards conveys an imppropniate message to acutely ill patients. The ward milieu may inadvertently present a picture of chronicity and tong-term dependence on the hospital. Such a milieu is at cross purposes with the treatment needs of acutely ill patients, in whom staff hope to instill an attitude of optimism and belief in their ability to function independently. The seriousness of the implications of use of acute cane beds by nonacute patients indicates that furthen research on this issue is warranted. PAuL JAMES
DAN
R.
KING,
L.
DuFFY,
PESSOTFO,
Dr. King is chiefpsychologist at North Bay Psychiatric Hospital in North Bay, Ontario. Dr. Duffy is a psychiatrist in private practice in Richmond, British Columbia. Mr. Pessotto is a medicalstudent at the University of Toronto.
Psychiatry
1. Bigelow DA, Characteristics
Cutler DL, Moore of state hospital
who are hard to place. munity
Psychiatry
Hospitaland
39:181-185,
U, et al: patients
Corn1988
GellerJL, Costello DJ, et a!: Projecting inpatient admissions to state facilities in the 1990s. Hospital and Community Psychiatry 40:747-749, 1989
3. Mezzich
WH,
JE,
Coffman
fluencing length and Community
1264,
November
1270,
GE:
ofhospita!
Factors instay. Hospital
Psychiatry
36:1 263-
1985
1992
Vol. 43
No.
11
J:
B, Rochon
stay units, Canadianjournal
and
Length
of stay,
enrgency
short
admissions.
ofPsychiatry
34:39-42,
1989 5. Caton
M, Gralnick A: A review of issurrounding length of hospitalizaHospital and Community Psychiatry 38:858-863, 1987
sues tion.
DSM-IV
in Progress
(Continuedfrompage
1076)
1401-1405,
1980
2.
PurtellJJ, vations JAMA
3.
MJ, Guze SB: Hysteria: stability and usefulness ofclinical na: a quantitative study based on low-up period ofsix to eight years patients. New England Journal of icine 266:421-426, 1962
4.
Robins on clinical 146:901-909,
E, Cohen aspects
ME: Obserof hysteria.
1951
Perley
Feighner
JP,
Robins
Diagnostic criteria research. Archives 26:57-63, 1972
the cnitea folin 39 Med-
E, Guze SB, en a!: fur use in psychiatric ofGenera! Psychiatry
AJ: Somatoform disorders, in Comprehensive Textbook of Psychiatry, 5th ed, vol 1. Edited by Kaplan HI, Sadock BJ. Baltimore, Williams & Wilkins, 1989
5. Barsky
6. Qoninger
Somatoform and disin The Medical Basis of Psychiatry. Edited by Winokur G, Clayton P. Philadelphia, Saunders, 1986
7.
CR:
sociative
disorders,
Cloninger
CR,
Martin
a!: A prospective study
RI,
follow-up
of somatization in American Journal
men.
143:873-878,
Guze
SB, et family men and woof Psychiatry
and
1986
8. Robins LN, HelzerJE, Weissman MM, et a!: Lifetime prevalence ofspecific psychiatric disorders in three sites. Archives ofGeneral
9.
10.
References
2. Fisher
4. Baker
PH.D. M.D. B.Sc.
three
years studied, approximately onefifth ofthe hospital’s acute inpatient resources were utilized for purposes other than acute care. This serious erosion of acute care resources has at least four implications for the hospital studied. The first and most obvious is that the facility’s clinical program is compromised by the reduction in the num-
Hospital
ben ofacute
Psych
41:949-958,
1984
WOodrUff RA Jr. Clayton PJ, Gaze SB: Hysteria: studies of diagnosis, outcome, and prevalence. JAMA 215:425-428, 1971 Martin general
R: Somatoform disorders in the hospital setting, in Handbook of on General Hospital Psychiatry.
Studies Edited
byJudd
DR.
New York,
FK, BurrowsGD, Elsevier, 1991
Lipsitt
1 1. C!oninger CR, Yutzy SY: Somatofbrm and dissociative disorders: a summary of changes for DSM-W, in Current Psychi-
atnic
Therapy. Philadelphia,
Edited Saunders,
by Dunner in press
12. The KD-l0ClassificationofMenta! tions,
and
Disorders, Diagnostic
neva,
World
Health
Behavioral
Clinical
Organization,
DL.
and Descnip-
Guidelines.
Ge1992
1149
