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Variation in clinical care associated with weekend admission and discharge in psychiatric inpatient units: retrospective case-note review

Variation in clinical care associated with weekend admission and discharge in psychiatric inpatient units: retrospective case-note review
Variation in clinical care associated with weekend admission and discharge in psychiatric inpatient units: retrospective case-note review
BACKGROUND: Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from inpatient units at weekends.

AIMS:
To compare the quality of care received by service users with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends, with those admitted or discharged during the ‘working week’.

METHOD: Retrospective case-note review of 3795 admissions to inpatient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.

RESULTS: 795 (20.9%) service users were admitted at weekends, and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between service users admitted at weekends and those admitted during the week. Service users discharged at weekends were less likely to be given sufficient prior notification (48 hours) in advance of being discharged (OR= 0.55, 95% CI 0.39 to 0.78), to have a crisis plan in place (OR= 0.65, 95% CI 0.46 to 0.92), or to be given medication to take home (OR= 0.45, 95% CI 0.30 to 0.66). They were also less likely to have been assessed with a validated outcome measure (OR=0.70, 95% CI 0.50 to 0.97).

CONCLUSION: There is no evidence of a ‘weekend effect’ for service users admitted to psychiatric hospital at weekends, but the quality of care offered to service users who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.
2056-4724
1-6
Williams, Ryan
8921f55d-7c1b-4e01-b648-28024e5148fd
Farquharson,, Laura
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Rhodes, Ellen
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Dang, Mary
7dfd9a9a-b561-4c26-b1ae-5a9c5d560f9e
Lindsey, Natasha
b303a9a5-cc94-48e3-8e35-802a51a8437b
Quirk, Alan
68fbb952-64ad-4c2d-995b-881d4bc7a6be
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Crawford, Mike J.
1fafb17d-8c42-45c2-9f0a-bab7040566a6
Williams, Ryan
8921f55d-7c1b-4e01-b648-28024e5148fd
Farquharson,, Laura
1e559294-52a2-4931-b3e0-cad4260ac1d8
Rhodes, Ellen
f09dde3e-f0b8-4713-980b-39e21f2d36c1
Dang, Mary
7dfd9a9a-b561-4c26-b1ae-5a9c5d560f9e
Lindsey, Natasha
b303a9a5-cc94-48e3-8e35-802a51a8437b
Quirk, Alan
68fbb952-64ad-4c2d-995b-881d4bc7a6be
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Crawford, Mike J.
1fafb17d-8c42-45c2-9f0a-bab7040566a6

Williams, Ryan, Farquharson,, Laura, Rhodes, Ellen, Dang, Mary, Lindsey, Natasha, Quirk, Alan, Baldwin, David and Crawford, Mike J. (2020) Variation in clinical care associated with weekend admission and discharge in psychiatric inpatient units: retrospective case-note review. BJPsych Open, 6 (5), 1-6. (doi:10.1192/bjo.2020.88).

Record type: Article

Abstract

BACKGROUND: Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from inpatient units at weekends.

AIMS:
To compare the quality of care received by service users with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends, with those admitted or discharged during the ‘working week’.

METHOD: Retrospective case-note review of 3795 admissions to inpatient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.

RESULTS: 795 (20.9%) service users were admitted at weekends, and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between service users admitted at weekends and those admitted during the week. Service users discharged at weekends were less likely to be given sufficient prior notification (48 hours) in advance of being discharged (OR= 0.55, 95% CI 0.39 to 0.78), to have a crisis plan in place (OR= 0.65, 95% CI 0.46 to 0.92), or to be given medication to take home (OR= 0.45, 95% CI 0.30 to 0.66). They were also less likely to have been assessed with a validated outcome measure (OR=0.70, 95% CI 0.50 to 0.97).

CONCLUSION: There is no evidence of a ‘weekend effect’ for service users admitted to psychiatric hospital at weekends, but the quality of care offered to service users who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.

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Weekend Variation - BJPsych - main document revision 3 'clean' - Accepted Manuscript
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More information

Accepted/In Press date: 10 August 2020
e-pub ahead of print date: 3 September 2020

Identifiers

Local EPrints ID: 443438
URI: http://eprints.soton.ac.uk/id/eprint/443438
ISSN: 2056-4724
PURE UUID: ed280e77-0e5b-403e-8c39-bdffc0e58d84
ORCID for David Baldwin: ORCID iD orcid.org/0000-0003-3343-0907

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Date deposited: 25 Aug 2020 16:32
Last modified: 10 Jan 2022 05:29

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Contributors

Author: Ryan Williams
Author: Laura Farquharson,
Author: Ellen Rhodes
Author: Mary Dang
Author: Natasha Lindsey
Author: Alan Quirk
Author: David Baldwin ORCID iD
Author: Mike J. Crawford

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