Using continuous quality improvement strategies to reduce repeated admissions for inpatient psychiatric treatment

A multidisciplinary performance improvement team was chartered to examine the problem of repeated admissions to psychiatric hospitals. It was also asked to devise an intervention strategy to reduce the number of readmissions, including the number of patients with three or more admissions in a 12-month period and the number of days patients spend in hospital beds. Multivoting, benchmarking, and a review of medical records for 88 psychiatric patients who had been hospitalized three or more times in 1 year were the methods used to gather data on client characteristics. An analysis of the data suggested that these high-end users had similar patterns of service utilization prior to their hospitalizations. The team identified 11 of these patterns as triggers that appear to signal early stages of decompensation that can lead to hospitalization. The team implemented an early intervention and prevention system by using the triggers as criteria for initiating a change in treatment plans. A study of the effectiveness of the Triggers Intervention and Prevention System (TIPS) was undertaken over the next 2 years. An automated program for deriving the triggers from the emergency services database was developed. Initial results that TIPS is an effective means of reducing recidivism and that the triggers can identify high-end users. Some of the triggers were deemed to be more effective than others in the early identification of individuals who may need to be hospitalized. A comparison of hospitalization rates for the pre- and postimplementation periods of TIPS showed a significant reduction in the number of patients who had three or more hospitalizations, fewer total admissions, and a shorter average length of stay. During 1995, the triggers were successful in the early identification of all patients who had more than one admission. The teams used the Design, Measure, Assess, Improve method recommended by the Joint Commission on Accreditation of Healthcare Organizations.