On the basis of a prospective random sample investigation of 611 alcohol-related visits to the four psychiatric emergency units of the City of Copenhagen, demographic variables, referral sources and dispositions of treatment are described. On every 10th day throughout 1985 all visits were registered. The distribution of all variables except age and sex deviate significantly from those of non-alcohol-related visits. Thus fewer alcoholics cohabit and more are divorced. 25% of the alcohol-related visits resulted in an overnight stay in the unit, while 10% resulted in admission to the psychiatric ward. For non-alcohol-related visits the proportions were the reverse.
Over a two week period (1994) the 27 physicians at Fjorden registered the time they used on direct and indirect treatment of in- and out-patients, administration, further training, supervision and research. Standardized criteria for the time spent on patient treatment were set up. Thirty-two percent of the total work time was used for direct treatment and a further 32% for indirect treatment (conferences, etc.) while the rest was used for other purposes. In relation to standardized 60 minutes or more treatment sessions, the survey revealed an average of 32-60% insufficient time spent on each patient per session. Fifty percent more physician time for direct treatment would be necessary to reach the standardized criteria for the total number of patients. We conclude that using 2/3 of the total work time available on treatment is acceptable. The great discrepancy between real and ideal use of physician time makes it important to further examine how to acknowledge dialogue as a psychiatric tool.
Over a two week period (1994) the 27 physicians at a psychiatric hospital registered the time used on indirect treatment (conferences, rounds, etc.). This amounted to 21-37% of total time, while time spent on administration amounted to 7-46% of total time depending on the seniority of the doctor involved. An estimated one hour per week per patient was used for indirect treatment. An insignificant amount of time was spent on interviews with relatives. We conclude that although it would be desirable to reduce the time spent on indirect treatment, the new demands made on community psychiatry with involvement of relatives, etc., would rather tend to give rise to more obligations in this area.
Postgraduate training for young doctors is an obligation for clinical departments. However there is a general impression that it has been difficult to acknowledge training as an activity in importance to patient treatment, and thus to give it the necessary priority. For a period of two weeks in 1994, all activities performed by doctors at a psychiatric hospital during working hours were registered. Special attention was given to activities concerning training and educational issues. These consisted of element such as theoretical courses, tutoring in daily clinical work and supervision of psychotherapy giving sessions. Furthermore it was registered whether the doctor had been receiving or giving the training. Junior registrars, senior registrars and consultants used 15, 13 and 5% of their time on training activities, however, during the period concerned the activities mainly consisted of attending external courses. Tutoring in the daily clinical work was non-existent. It is proposed that clinical positions that have training as a described part of their function should be secured.
All patients contacts at the four psychiatric emergency rooms in Copenhagen and Frederiksberg were registered every tenth day during 1985 (a total of 1969 patient contacts). Based on this material, we have compared patients who were given the diagnosis schizophrenia with other patients attending the psychiatric emergency rooms as regards demographic data, attendance patterns and treatment. There were 387 contacts from schizophrenic patients, of which 69.8% were men and 30.2% women. The schizophrenic patients were significantly younger than the other patients, and significantly more of them were unmarried, living alone and on pensions. A quarter of the schizophrenic patient contacts ended in hospital admission, either directly or after spending the night in the emergency room, 10% spent the night only, and 65% left the emergency room the same day with or without further appointments. There were signs that many of the schizophrenic patients, especially the men, used the emergency rooms as a means of human contact and a "shelter", compensating for the lack of a more personal social network. This is seen in connection with the fact that the male patients were to a greater degree without a family network. On the other hand, significantly more female schizophrenic patients were admitted to hospital or were offered overnight stays in the emergency room. Schizophrenic patients are regarded as large-scale users of psychiatric emergency rooms, which is seen in relation to recent years' limited capacity for hospital admission and lack of relevant options for housing, treatment and rehabilitation. The plans for community psychiatry in Copenhagen are expected to consider the special problems which these patients face.