Shorter stays linked to rapid rehospitalization

While they aren’t ready to draw a direct cause-and-effect relationship between the two data points, researchers at the Treatment Advocacy Center have released a study that shows states that hospitalize severely ill psychiatric patients for shorter periods of time have higher readmission rates within six months of discharge than state hospitals with longer median stays.

The findings are part of “Released, Relapsed, Rehospitalized: Length of Stay and Readmission Rates in State Hospitals, a Comparative State Survey,” an analysis of federal data from 2015 by the Treatment Advocacy Center, a national not-for-profit group. The report finds patients at state hospitals with the shortest length of stay were three times more likely to be readmitted to a state hospital within 30 days and 180 days than patients with the longest initial stays.

“It just makes sense if you aren’t able to take the time to ensure person is on the right medication, the medication is working effectively and that they’re stabilized,” says John Snook, executive director of the Treatment Advocacy Center and the report’s senior author. “It’s unsurprising that you are going to see an increase in readmissions.”

In 1955, there were 560,000 state hospital beds for an estimated 3.3 million American adults living with serious mental illness and other disabilities. In early 2016, the number of beds had dropped to 38,000 while the number of Americans facing such conditions rose to 8.1 million.

Without an adequate number of beds, Snook says, state hospitals are discharging patients prematurely to accommodate forensic patients or those who are being sent to treatment under court orders.

“We have state after state being hit by lawsuits because people are being trapped basically in jail as they wait for a state hospital bed,” Snook tells Behavioral Healthcare Executive. “Those people have a constitutional right to get into that bed, and that only provides more pressure on state hospitals to say ‘those individuals who get here without a crime, we’ll have to minimize their stay.’ And that’s a terrible situation for us to be in, to say the way to get long-term care is to be arrested and go to jail.”

To help alleviate some of the strain on state hospitals, Snook says the Treatment Advocacy Center is now working on a formula that will help the facilities quantify how adding beds would reduce the wait for forensic patients to receive treatment.

“That will be a helpful tool,” Snook says. “We have lots of states that are just guessing as to how many hospital beds they need.”