Inpatient care, including intensive care, remains essential for management of patients who are at risk of suicide or too agitated or hostile to manage safely in their own homes.
Good practice in inpatient care is achieved in many units but requires leadership, management support, adequate staffing, therapeutic input, and advocacy in well designed and maintained environments41 73
The establishment of admission assessment ‘triage’ units is beginning to spread e.g. South Essex Partnership Trust where in the first 2 years of establishing the unit they saw:
- A 36% reduction in admissions through A & E units with an overall reduction in in-patient admissions of 42%.
- The average wait for allocation of beds was also halved and use of out of area beds has been reduced to zero.
- However, there has been an increase in the average length of stay as an in-patient which may be accounted for by the increased proportion of severely unwell patients on the wards.
- The trust has found a substantial financial benefit including closure of a 23 bed acute in-patient unit and staff satisfaction surveys have also found that staff in particular junior doctors find the work of this unit extremely helpful74.