Utilization and outcome in an overnight psychiatric observation program ata Veterans Affairs Medical Center

Objective: The effectiveness of an overnight psychiatric observation progra m was evaluated. The program was designed to avoid unnecessary hospitalizat ion of patients experiencing acute psychiatric crises. Methods: Of 110 pati ents admitted to the observation unit at a Veterans Affairs medical center over a sis-month period in 1996, the charts of 92 patients were retrospecti vely reviewed. Characteristics of patients referred to the program were doc umented, inpatient hospitalization rates and suicide rates in the six-month periods before and after admission to the observation unit were examined, and variables related to the need for hospitalization immediately after obs ervation were explored. Results: Most of the 92 patients (98 percent) were referred from the medical center's emergency room. At the time of observati on, 80 percent of the patients were unemployed, 55 pelt cent expressed suic idal or homicidal ideation, 49 percent were intoxicated or at risk for alco hol withdrawal, and 41 percent were homeless. The most frequent psychiatric diagnosis was substance abuse or dependence (77 percent). The large majori ty of patients (88 percent) were referred the next day to other outpatient programs for follow-up and treatment, which avoided, costly inpatient treat ment. In the sis:months before admission to the observation program, the me an number of inpatient psychiatric bed days was 9.8, compared with 2.7 days in the six-month period after discharge from the observation program. No i ncrease in suicide gestures or attempts was noted among the patients. No va riables significantly predicted admission to inpatient care after the obser vation period. Conclusions: Overnight observation programs may provide a co st-effective alternative to traditional inpatient treatment for some indivi duals with psychiatric disorders.