New long-stay patients on acute psychiatric units: does audit change practice?

Patients who have prolonged stays on acute psychiatric wards are a feature of many modern community psychiatric services. The present study aimed to determine if the care delivered to these patients could be improved by reflecting back to practitioners easily auditable components of the patients' care. The subjects comprised patients resident on the acute psychiatric units in Sheffield for more than six months. These patients were surveyed in April 1995 and again in February 1996. After the first survey, clinicians received a presentation and feedback regarding aspects of their patients' care. The results demonstrated there had been little change in the percentage of acute bed capacity occupied by patients with inpatient stays in excess of six months, despite improvement in many of the audit standards. The main reason for prolonged inpatient treatment was continued mental state or behavioural disturbance. The mean length of stay of patients in this category actually increased. The results suggest that a simple audit exercise can improve the quality of care delivered to this group of patients, but that they will continue to occupy a substantial proportion of acute bed capacity in the absence of suitable alternative treatment settings.