Variables related to the bed-blocker phenomenon in an acute psychiatric ward

Background The term “bed-blockers” was created in the 70s to indicate those patients who, after completing diagnostic tests and therapeutic treatment, continued to occupy hospital beds unnecessarily . Due to economic reasons, this phenomenon has been increasingly investigated, but few studies evaluated it in psychiatric wards. Aims To assess the frequency of psychiatric long-term hospitalizations and related variables. Methods From database of an acute psychiatric ward (SPDC-Modena), all hospitalizations from 1-1-2005 to 31-12-2010, with duration  the 90th percentile (28 days) were selected. Frequency, psychiatric diagnosis and comorbidities of this sample (n=345) were compared with those of all other admissions in the same period (chi square test). The sample was divided into two subgroups, according to the median duration of hospitalization: A (245 hospitalizations up to 46 days) and B (100 hospitalizations exceeding 46 days). Demographic data (age, gender, nationality), clinical variables (psychiatric and organic diagnosis, according to ICD-9-CM, VGF and CGI-I scores at the discharge, pharmacotherapy), inpatient care problems (extra-psychiatric clinical activities, aggressiveness with and without restraint, activation of residential care services) and discharge needs (protected structure, nursing home, new hospitalization, home care, economic support, etc.) of A group were compared to B group ones (univariate and multivariate logistic regression). Results The 345 hospitalizations represented 8% of all psychiatric hospitalizations and differed from others due to higher frequency, statistically significant, of both “schizophrenia and other psychotic disorders” and associated organic comorbidities. The variables statistically significantly related to the length of hospitalization were: “inpatient and outpatient care network” as protective factor, “aggressiveness with restraint” and “non psychiatric clinical activities” as risk factors. Conclusions The risk of psychiatric long-stay appeared related to the same clinical factors which can induce institutional dependence. Integrated collaboration between hospital and outpatient services could significantly counteract this clinical and social issue.