Impediments to the discharge planning effort for psychiatric inpatients

This study investigates a methodology to systematically track the effort to overcome impediments to securing needed post-hospital care and support.

494 consecutive admissions to the Mount Sinai Medical Center were evaluated for the quality of available support resources in the domains of housing, daily activity, and psychiatric treatment using the Mount Sinai Discharge Planning Inventory. On day seven, the same rater recorded the optimal discharge plan for each resource category and those impediment codes that were likely to interfere with attaining the desired resource. On discharge, the rater recorded the actual resources obtained for the patient, and if the plan did not meet the patient's needs, an impediment code was used to explain why the sub-optimal "discharge fit" was not secured.

Having an impediment in any of the three resource categories (housing, daily activities, psychiatric treatment services) at day 7 was predictive of a sub-optimal discharge plan. Of all three resource categories studied, a decline in overall impediments from day 7 to discharge was significant only for psychiatric treatment services. An internal/clinical impediment in any of the three resource categories on day 7 was associated with a patient history of alcohol and drug abuse. A significant association was found between having external/environmental impediments identified at discharge for housing and psychiatric treatment services with return to the hospital within 90 days of discharge.

Study of the impediments to the discharge planning effort provides an opportunity to elucidate the factors that comprise the pathway of recovery from psychiatric illness, but which are normally ill-defined, poorly understood, or not readily measured.