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Efficacy of a triage system to reduce length of hospital stay

  • P. Williams (a1), E. Csipke (a2), D. Rose (a3), L. Koeser (a1), P. McCrone (a1), A. D. Tulloch (a1), G. Salaminios (a2), T. Wykes (a4) and T. Craig (a5)...
Abstract
Background

Attempts have been made to improve the efficiency of in-patient acute care. A novel method has been the development of a ‘triage system’ in which patients are assessed on admission to develop plans for discharge or transfer to an in-patient ward.

Aims

To compare a triage admission system with a traditional system.

Method

Length of stay and readmission data for all admissions in a 1-year period between the two systems were compared using the participating trust's anonymised records.

Results

Despite reduced length of stay on the actual triage ward, the average length of stay was not reduced and the triage system did not lead to a greater number of readmissions. There was no significant difference in costs between the two systems.

Conclusions

Based on our findings we cannot conclude that the triage system reduced length of stay, but we can conclude that it does not increase the number of readmissions as some have feared.

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Copyright
Corresponding author
Emese Csipke, Department of Psychology, Institute of Psychiatry, 16 De Crespigny Park, London, SE5 8AF, UK. Email: emese.1.csipke@kcl.ac.uk
Footnotes
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Joint last authors.

This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1050). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Declaration of interest

None.

Footnotes
References
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11 Greater London Authority. English Indices of Deprivation 2010 A London Perspective. Greater London Authority, 2010.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Supplementary Table S1-S5

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Efficacy of a triage system to reduce length of hospital stay

  • P. Williams (a1), E. Csipke (a2), D. Rose (a3), L. Koeser (a1), P. McCrone (a1), A. D. Tulloch (a1), G. Salaminios (a2), T. Wykes (a4) and T. Craig (a5)...
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eLetters

A good service hampered by financial restrictions on community services?

Steven R Hemblade, CT2
13 June 2014

An interesting article and very timely given recent news reports regarding the bed status within Mental Health.

For a while, I've wondered whether a triage system would work, with the primary aim to reduce bed occupancy. This article highlights that it clearly does work, but not to a significant effect. Concerns regarding re-admission were also not found in this study. If the triage system was combined with a 'rehabilitation-focused' setting, would this reduce overall stay?

One thing I have noticed over the last couple of years is the declinein respite beds. Having covered the local A&E out of hours, it's frustrating when a patient has the potential for a respite bed, but there are none available. Surely this would reduce bed occupancy and cost. I canimagine a triage system working well with a 'step-down' respite system, where-by patients can be assessed within the 10 days, treated and discharged to the respite accommodation, with less over-head costs.

A couple of points regarding the study. It is mentioned within the discussion about "patients needing to assimilate into a new clinical team may delay discharge". This is probably evident across the country. Often patients are awaiting referrals to community teams. I couldn't see in the article how many patients were already known to community services prior to admission and whether this had an impact on the outcomes.

Additionally, I assumed the two systems were run by different consultants. If this is the case, there is often a significant difference between consultants' practice and risk management which could be a confounder. There was also a higher number of drug-related disorder and personality disorder patients that were admitted to the triage system (combined totals of 166 vs 96) which would have an effect on discharge management.

Ultimately, we need to find a system to reduce inpatient stay, thoughI fear this will always be hampered by limitations put on resources due tofinances.

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Conflict of interest: None declared

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