A new model for quality improvement in acute inpatient psychiatry: observational data from an acute assessment unit

OBJECTIVES: There is little research into the constituents of effective psychiatric inpatient care. The aim of this study was to assess the effectiveness of a newly adopted model of inpatient care; the acute assessment ward. DESIGN: Review of data collected over a year-long period. SETTING: Acute assessment ward in North London. PARTICIPANTS: All Admissions between 8 October 2009 and 7 October 2010. MAIN OUTCOME MEASURES: Duration of stay, need for readmission, patient satisfaction and frequency of conflict behaviours. RESULTS: A total of 485 admissions over the yearlong study period. The median stay to discharge from the assessment ward was 6 days, whereas in those transferred it was 19 days. Readmission within 28 days following discharge from the assessment ward was 13.9%, whereas those discharged from other wards was 9.2% (P = 0.1). Patient satisfaction was no lower, for all domains, than for other wards in the trust. Frequency of conflict behaviour was equal to previous studies,(1) but self harm was significantly less common (P = 0.01). CONCLUSIONS: Our data show that focusing on the ‘point of entry’ to inpatient services means that some admission times can be reduced without an increase in 28-day readmission rates or conflict behaviours. The acute assessment model attempts to address the need for the NHS to deliver more for less, whilst remaining focused on service-user and staff satisfaction. Research into which areas of this complex intervention are effective is challenging, but we would urge others who run services with novel structures to publish data about their functioning.