Time to readmission in psychiatric inpatients with a therapeutic leave

Interventions to decrease readmissions in psychiatric patients are urgently needed. In Switzerland therapeutic leave (TL) composes a cornerstone of inpatient treatment. TL is a planned time-limited absence from the inpatient ward giving patients the opportunity to test their resilience in their usual environment. Evidence of its applicability as an intervention reducing readmissions is lacking. Therefore, our objective was to examine the association between TL and readmission risk.

Using the Kaplan-Meier curve we compared the time to readmission of 3'302 inpatients at the UPK Basel with and without TL. Cox regression was applied, integrating other covariates associated with readmission.

The Kaplan-Meier curve indicated longer cumulative survival in patients with TL. The log-rank test implied statistical significance (χ²(1) = 18.8, p < .05). The Cox regression showed a reduced hazard for patients with TL (HR = 0.735, CI 95% = [0.639, 0.846], p < .001) and for involuntarily hospitalized patients (HR = 0.760, CI 95% = [0.618, 0.934], p < .01). A higher readmission risk was found for a history of psychiatric admissions (HR = 1.005, CI 95% = [1.004, 1.005], p < .001), higher severity of symptoms at admission (HR = 1.029, CI 95% = [1.018, 1.040], p < .001), comorbidity (HR = 1.178, CI 95% [1.024, 1.355], p = .022), and a diagnosis with schizophrenia-spectrum disorders (HR = 1.401, CI 95% [1.164, 1.687], p = .001).

Linking TL with readmission risk, our results imply an easy way to improve quality of care, with possible implications for practice, policies and quality interventions. TL might be suitable to enhance recovery, reduce readmissions and health care costs. RCTs are needed for validation.