Evaluation of the Transitional Discharge Model on use of psychiatric health services: an interrupted time series analysis.

Abstract

INTRODUCTION\nThe Transitional Discharge Model (TDM) bridges hospital discharge and community living for people receiving psychiatric services. TDM, based on Peplau s theory of interpersonal relations, ensures continued support from hospital staff until a therapeutic relationship is established with community providers, and formal peer support.\n\n\nAIM\nTo compare temporal trends in psychiatric health services use before and after TDM implementation within acute and tertiary care psychiatric units in Ontario, Canada.\n\n\nMETHOD\nUsing health administrative databases, monthly discharges from psychiatric units three years prior, to two years after TDM implementation were identified. Median inpatient length of stay (LOS), psychiatric readmission rates, and mental health-related emergency department visit rates were compared using segmented regression analyses.\n\n\nRESULTS\nAmong acute care units, median LOS decreased significantly below the projected historical trend following TDM implementation, while readmissions increased significantly and declined thereafter. No significant changes were found for tertiary care units.\n\n\nDISCUSSION\nStudies on various interventions have shown decreased readmission rates, whereas the trend differed between acute and tertiary care units in this study. Possible reasons include different patient needs and staff practices.\n\n\nIMPLICATIONS FOR PRACTICE\nNeeds of people from different unit types should be considered when implementing TDM. Nurses should recognize the development of therapeutic relationships and availability of peer support resources.