PMID- 26693048 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20151222 LR - 20181113 IS - 2155-7772 (Print) IS - 2155-7780 (Electronic) IS - 2155-7780 (Linking) VI - 17 IP - 4 DP - 2015 TI - The 23-Hour Observation Unit Admissions Within the Emergency Service at a National Tertiary Psychiatric Hospital: Clarifying Clinical Profiles, Outcomes, and Predictors of Subsequent Hospitalization. LID - 10.4088/PCC.15m01789 [doi] AB - OBJECTIVE: We examined health care utilization, clinical profiles (such as sociodemographic features, clinical severity), and outcomes (inpatient admission, revisit within 24 hours of discharge) of patients who were admitted to a 23-hour observation unit within the emergency service of a tertiary psychiatric hospital and hypothesized that a specific clinical profile (greater clinical severity, lower psychosocial functioning) predicted subsequent inpatient hospitalization. METHOD: The medical records of all patients admitted to the observation unit from February 5, 2007, to February 4, 2012 (N = 2,158) were assessed for relevant data. Clinical severity and level of psychosocial functioning were assessed using Clinical Global Impressions-Severity (CGI-S) and Global Assessment of Functioning (GAF) scales, respectively. RESULTS: Overall, the patients seen were predominantly Chinese males > 36 years old who had diagnoses including stress-related, anxiety, affective spectrum, and psychotic disorders. The clinical severity score (CGI-S) improved significantly following discharge from the observation unit (t 1,1848 = 23.316; P < .001). Logistic regression analyses revealed that self-referred (P = .001), older patients (P = .007) with past psychiatric history (P = .019), lower GAF scores (P = .025), and less improvement of CGI-S scores (P = .001) were associated with inpatient admission after a 23-hour stay in the observation unit. CONCLUSIONS: Our study findings affirmed our hypothesis and supported the utility of the observation unit in monitoring the overall clinical status of patients, which was linked with subsequent inpatient admissions. Better management of these patients at the outpatient level can potentially decrease unnecessary hospitalization and reduce health care cost as well as illness burden on patients and caregivers. FAU - San Thinn, Daw San AU - San Thinn DS AD - Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum). FAU - Kuswanto, Carissa Nadia AU - Kuswanto CN AD - Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum). FAU - Sum, Min Yi AU - Sum MY AD - Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum). FAU - Chai, Suet Bin AU - Chai SB AD - Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum). FAU - Doris Sok, Hian Koh AU - Doris Sok HK AD - Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum). FAU - Xu, Changqing AU - Xu C AD - Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum). FAU - Chuan Su, Alex Hsin AU - Chuan Su AH AD - Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum). FAU - Sengupta, Somnath AU - Sengupta S AD - Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum). FAU - Jacob, Rajesh AU - Jacob R AD - Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum). FAU - Sim, Kang AU - Sim K AD - Department of General Psychiatry, Institute of Mental Health, Singapore (Drs San San Thinn, Chai, Su, Sengupta, Jacob, and Sim and Mss Koh and Xu); and Research Division, Institute of Mental Health, Singapore (Mss Kuswanto and Sum). LA - eng PT - Journal Article DEP - 20150716 PL - United States TA - Prim Care Companion CNS Disord JT - The primary care companion for CNS disorders JID - 101547532 PMC - PMC4664576 EDAT- 2015/12/23 06:00 MHDA- 2015/12/23 06:01 PMCR- 2015/07/16 CRDT- 2015/12/23 06:00 PHST- 2015/01/22 00:00 [received] PHST- 2015/03/24 00:00 [accepted] PHST- 2015/12/23 06:00 [entrez] PHST- 2015/12/23 06:00 [pubmed] PHST- 2015/12/23 06:01 [medline] PHST- 2015/07/16 00:00 [pmc-release] AID - 15m01789 [pii] AID - 10.4088/PCC.15m01789 [doi] PST - epublish SO - Prim Care Companion CNS Disord. 2015 Jul 16;17(4):10.4088/PCC.15m01789. doi: 10.4088/PCC.15m01789. eCollection 2015.