The authors describe an external crisis intervention service in a general hospital. This service is intended for a clientele presenting acute mental health problems, referred, in the majority of cases, from the emergency department. They present demographic data, diagnostic data, data on the factors precipitating the crises and data which can be used to qualify and quantify the clientele. In addition, they describe the therapeutic approach and the treatment philosophy, the number of follow-up sessions, and the guidance provided to the clientele after follow-up. Finally, the authors suggest prerequisites considered essential to the effective operation of a crisis intervention module in an external psychiatric clinic.
This study describes psychogeriatric patients who visit the Emergency Room (ER) in a teaching hospital with a comprehensive psychogeriatric service.
A survey assessing demographic and clinical characteristics was completed for every psychiatric ER patient during a 2-year period.
One hundred and seventy-three ER patients aged over 60 (mean age 71.2) were assessed. Fifty-three percent were previously known to the psychogeriatric service. The majority of these previously known psychogeriatric patients who used the ER suffered from mood disorders. The majority of new psychogeriatric patients seen in the ER had an organic brain syndrome (OBS).
Few OBS patients who visited the ER were previously known to the psychogeriatric service, but many new OBS patients accessed the psychogeriatric service via the ER. For patients with mood disorders, particularly if suicidal, the ER was used as part of their service delivery system.
Contacts to the health care system prior to suicide: a comprehensive analysis using registers for general and psychiatric hospital admissions, contacts to general practitioners and practising specialists and drug prescriptions.
OBJECTIVE: The purpose of this study was to describe suicides' contacts with various parts of the health-care system. METHOD: Data on 472 people who committed suicide in a Danish County (Funen) in the period of April 1 1991 to December 31 1995 were searched in the Danish Psychiatric Central Register, the National Patient Register, the National Health Insurance and Odense Pharmacoepidemiologic Database. RESULTS: In total, 97.5% of the suicides were recaptured in at least one of these registers. Forty-two per cent had been hospitalized in psychiatric departments. Within the last month before death, 66% consulted a general practitioner, 13% and 7%, respectively, were discharged from a psychiatric hospital and general hospital. CONCLUSION: The registers used provided a comprehensive registry-based description of suicides' contacts with the health-care system. The most prominent features were the high prevalence of psychiatric morbidity and the high rate of contacts with GPs close to suicide.
STUDY OBJECTIVE: To assess whether populations with access to general practitioner hospitals (GP hospitals) utilise general hospitals less than populations without such access. DESIGN: Observational study comparing the total rates of admissions and of occupied bed days in general hospitals between populations with and without access to GP hospitals. Comparisons were also made separately for diagnoses commonly encountered in GP hospitals. SETTING: Two general hospitals serving the population of Finnmark county in north Norway. PATIENTS: 35,435 admissions based on five years' routine recordings from the two hospitals. MAIN RESULTS: The total rate of admission to general hospitals was lower in peripheral municipalities with a GP hospital than in central municipalities without this kind of institution, 26% and 28% lower for men and women respectively. The corresponding differences were 38% and 52%, when analysed for occupied bed days. The differences were most pronounced for patients with respiratory diseases, cardiac failure, and cancer who are primarily or intermediately treated or cared for in GP hospitals, and for patients with stroke and fractures, who are regularly transferred from general hospitals to GP hospitals for longer term follow up care. CONCLUSION: GP hospitals seem to reduce the utilisation of general hospitals with respect to admissions as well as occupied bed days.
The Faroe Islands are a group of islands in the North Atlantic Ocean between Norway and Iceland inhabited by about 42,000 people. They are considered a nation with home rule within the Danish Kingdom. A Psychiatric Department was not established on the islands until 1969. Before this, psychiatric patients were referred to the local General Hospital and about half of the patients in each diagnostic group were sent on the Psychiatric Hospital in Nykøbing on Zealand, Denmark. Since the establishment of the department, admissions have increased in all diagnostic groups, especially in the group of senile psychoses. The total increase amounts to 2.4 times the admission rates of psychiatric cases to the General Hospital and 4.4 times the admission rates to the Psychiatric Hospital in Nykøbing in the last years prior to the start of the local service. The outpatient department has grown steadily, the patients attending are distributed in diagnostic groups similar to Danish outpatient departments.
OBJECTIVES: To assess necessary treatment and degree of urgency for patients admitted to emergency rooms, and potential health consequences of transfer to nearest alternative hospital. METHODS: During 1 month, we included all 1,300 emergently admitted patients in all seven general hospitals in a Norwegian county with a population of 236,921 inhabitants. The number of patients in need of surgical and/or intensive medical treatment, the urgency of the necessary treatment, and the risk to each patient of adverse permanent health consequences of further transport to nearest alternative hospital were assessed by a multidisciplinary expert panel. RESULTS: Ninety-four patients (7.2% of 1300 patients) were considered in need of either surgical (n = 22) or intensive medical treatment (n = 70) or both (n = 2) within 8 hours of arrival in hospital. Medical treatment had the greatest urgency, while surgery most often could be postponed. In cases where the patients were initially to be given only stabilizing treatment and then transported (assisted by qualified personnel) to another hospital, the panel estimated the risk of losing health benefit to be high for 14 patients. In six of these cases the risk was linked to delay of thrombolytic treatment. CONCLUSIONS: Fewer than 10% of the patients who are admitted as emergency cases to general hospitals in Norway need surgical or intensive medical treatment within 8 hours of their arrival. The medical consequences of transport of patients to the nearest alternative hospital are generally small and can often be further reduced by simple means.
The object of the study was to describe socioeconomic and demographic determinants of inpatient hospital care for lumbar intervertebral disc disorders (LIDD) in Finland. Information from the 1996 Finnish Hospital Discharge Register was linked with the 1995 Population Census. Poisson regression analyses were made with the total and the gainfully employed workforce aged 20-64 y as reference. All 48 public and seven private acute care general hospitals treating LIDD patients in Finland. In the workforce, 4643 patients aged 20-64 y (3692 among the gainfully employed) were admitted to the hospital due to LIDD (ICD-10: M51.1-M51.9) in 1996. About one-half were treated surgically. The duration of unemployment in 1995 was inversely associated with hospitalisation for LIDD in 1996, allowing for age, sex, education and personal income (unemployed for 12 months vs 0 months: rate ratio 0.66; 95% CI 0.57-0.77). Among those employed for 12 months in 1995, the level of education was inversely associated with the hospital admission rate. The rate was also higher in manual occupations as compared with the upper white-collar employees. The associations were clearer among the medically than the surgically treated patients. Hospitalisation for back disorder was, however, less common in the lowest income group as compared with the highest (0.65; 0.57-0.77) allowing for education, occupational class, age and sex. Women were less often admitted to the hospital than men, allowing for the socioeconomic factors (0.83; 0.77-0.90). When indicated by education or occupation, low socioeconomic status was associated with a relatively high rate of inpatient hospital care for LIDD. When indicated by personal income, the situation was the reverse. Unemployment and female gender predicted a relatively low rate of hospitalisation.