Efficiency of outpatient ECT

To compare the efficiency of acute-phase outpatient electroconvulsive therapy (ECT), maintenance ECT, and inpatient ECT regarding completion of scheduled treatments.

Psychiatric research suggests a trend toward greater use of outpatient ECT and that this modality may offer certain advantages over inpatient ECT. Possible concerns about outpatient ECT may be uncompleted treatments due to transportation problems, forgotten appointments, noncompliance with NPO status, or other variables more easily controlled in the inpatient setting. In addition, without the constant monitoring offered by the hospital setting, physicians prescribing outpatient ECT may less successfully gauge the number of required treatments.

Completion rates of all scheduled ECTs in a tertiary care hospital setting were monitored prospectively for 8 months. Completed treatment totals were estimated by numbers of outpatient treatments billed for, institutional policy prohibiting charges for missed appointments. Outpatients scheduled for more than 1 treatment per week were considered acute-phase patients; maintenance therapy was defined as 1 or fewer treatments per week.

Of 257 scheduled outpatient maintenance treatments, 91% were completed compared with 65% of 456 scheduled inpatient treatments. This difference was statistically significant (P < 0.0001; chi2 = 59.6; df = 1). Completion rate of acute outpatient treatments was 62% of 78 scheduled, showing a statistically significant difference from that of maintenance ECT (P < 0.0001; chi2 = 39.1; df = 1). No significant difference was detected between the completion rates of inpatient and acute outpatient ECT.

These findings suggest that the efficiency of maintenance ECT is high, comparing favorably with that of convulsive therapy for the acutely ill, and further support maintenance ECT as a useful and cost-effective modality.