Acute psychiatric admissions from an out-of-hours Casualty Clinic; how do referring doctors and admitting specialists agree?

Abstract

Background: Over the last decades there has been an increasing pressure on the acute psychiatricwards in Norway. The major contributor to psychiatric acute admissions at the University Hospitalof North Norway in the city of Tromsø in 2001 was the GP-based Tromsø Casualty Clinic, onlyopen out-of-hours. We explored all acute psychiatric referrals from Tromsø Casualty Clinic in2001. The purpose of the study was to characterize the admissions and assess the agreementbetween the referring doctors and the hospital specialists according to the need for hospitalization,agreement on application of the law and the diagnostic evaluation to assess whether the admissionswere appropriate.Methods: Retrospective, record based, descriptive study comprising 101 psychiatric acutereferrals from the Tromsø Casualty Clinic to the psychiatric acute wards at the University Hospitalof North Norway.Results: The specialists accepted all referrals except one, they mostly agreed upon the diagnosessuggested by the referring doctors and they mostly confirmed the application of the law.Seventy-five percent of the admissions took place during weekends, public holidays or nighttimes.Diagnoses of psychoses or suicidal attempts accounted for 76 % of the total referrals. Substanceabuse was noted for 43 %, and in 22 % of all admissions the patients had stopped taking theirpsychopharmacological medication. The police assisted the referring doctors in one third of alladmissions, and was the legal representative in 52 out of 59 involuntary admissions. Thirty percentof the admissions were first- time admissions. Thirty-two percent of the hospital stays lasted forthree days or less. Median length of stay was 6.5 days.Conclusion: The casualty clinic physicians and the hospital specialists mostly agreed in theirevaluation of patients indicating that most of the admissions were appropriate. The police wasmore often involved in the involuntary admissions than intended in the law. The proportion ofpatients with substance abuse was significant. Alternative treatment strategies should be developedfor non-psychotic patients in need of short-term stays.