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The purpose of this paper is to examine the trend of admissions and inpatient characteristics in a NHS intellectual disability hospital from 1975 to 2013, in particular looking at the effect following the Winterbourne View scandal.

A retrospective review of all admissions over a three-year period (January 2011-January 2013) was completed. This information was compared with admissions to the same hospital in three-year period over the last four decades (1975-1977, 1985-1987, 1995-1997, and 2003-2006). Number of admissions, gender, age, source of admission, length of stay, reasons for admission, type of admission, and diagnosis of psychiatric illnesses were included.

There were 87 admissions (including 29 from out of area) in the study period of 2011-2013. The number of admissions had varied over the years but male admissions were consistently higher than female. A majority of people stayed over six months. For the first time in five decades, there were more formal inpatients than informal ones. The diagnosis of Autism Spectrum Disorder (ASD) and of Attention Deficit Hyperactivity Disorder had increased.

This study has examined admission trends over five decades. It has highlighted that the Mental Health Act legislation is being used more frequently and that co-morbid mental disorders, such as ASD are commonly associated with those admitted to hospital. A well planned-out community health care system, as well as adequate social provision are keys to maintain people with intellectual disability in the community. Furthermore, a better understanding of the symptomology of challenging behaviours, and appropriate use of mental health legislation are crucial in providing a high-quality service that has clear treatment goals and values. Some of these issues have contributed to the failure of the recent initiative to reduce the size of the inpatient intellectual disability following Winterbourne View scandal.

Aims to assess the impact of a day‐care center (DCC) on hospital bed usage by HIV‐infected patients. Reviews the medical records of 710 hospital admissions of HIV‐infected patients admitted to two Spanish hospitals, one of them with a DCC, over a three‐year period. The proportion of unnecessary admissions was significantly higher in the hospital without a DCC. The rate of hospital admissions among patients who were admitted to hospital was also greater in the hospital without a DCC, as well as the rate of admissions among patients on antiretroviral drugs. Concludes that the availability of a DCC improves the appropriateness of hospital admissions and decreases the number of hospitalizations in HIV‐infected patients.

The purpose of this paper is twofold: first, to present patient-level utilisation patterns of hospital-based mental health services funded by private health insurers; and second, to examine the implications of the findings for planning and delivering private mental health services in Australia.

Analysing private health insurance claims data, this study compares differences in demographic and hospital utilisation characteristics of 3,209 patients from 13 private health insurance funds with claims for mental health-related hospitalisations and 233,701 patients with claims for other types of hospitalisations for the period May 2014 to April 2016. Average number of overnight admissions, length of stay and per patient insurer costs are presented for each group, along with overnight admissions vs same-day visits and repeat services within a 28-day period following hospitalisation. Challenges in analysing and interpreting insurance claims data to better understand private mental health service utilisation are discussed.

Patients with claims for mental health-related hospitalisations are more likely to be female (62.0 per cent compared to 55.8 per cent), and are significantly younger than patients with claims for other types of hospitalisations (32.6 per cent of patients aged 55 years and over compared to 57.1 per cent). Patients with claims for mental health-related hospitalisations have significantly higher levels of service utilisation than the group with claims for other types of hospitalisations with a mean length of stay per overnight admission of 15.0 days (SD=14.1), a mean of 1.3 overnight admissions annually (SD=1.2) and mean hospital costs paid by the insurer of $13,192 per patient (SD=13,457) compared to 4.6 days (SD=7.3), 0.8 admissions (SD=0.6) and $2,065 per patient (SD=4,346), respectively, for patients with claims for other types of hospitalisations. More than half of patients with claims for mental health-related hospitalisations only claim for overnight admissions. However, the findings are difficult to interpret due to the limited information collected in insurance claims data.

This study shows the challenges of understanding utilisation patterns with one data source. Analysing insurance claims reveals information on mental health-related hospitalisations but information on community-based care is lacking due to the regulated role of the private health insurance sector in Australia. For mental health conditions, and other chronic health conditions, multiple data sources need to be integrated to build a comprehensive picture of health service use as care tends to be provided in multiple settings by different medical and allied health professionals.

This study contributes in two areas: patient-level trends in hospital-based mental health service utilisation claimed on private health insurance in Australia have not been previously reported. Additionally, as the amount of data routinely collected in health care settings increases, the study findings demonstrate that it is important to assess the quality of these data sources for understanding service utilisation.

Admission scheduling is identified as an important strategy to match supply and demand in acute care hospitals. During the last decades, many different theoretical models of admission scheduling have been developed, but only a few of them have reached the stage of implementation. Several authors have given some indication that there may be a gap between theory and practice of admission scheduling. In this study we try to describe this gap using a two‐stage research methodology: an extensive literature review in order to determine the theoretical functional requirements for a system that supports the admission scheduling decision and a telephone survey in order to learn more about the admission scheduling practice in Belgian hospitals. The study finds a large gap between the theoretical requirements and the practical application of admission scheduling in hospitals. In summary, most hospitals have not worked out an admission scheduling policy indicating which resources are critical in the scheduling process and how information on the availability of these resources can be captured.

Physical comorbidities of alcohol misuse are common and result in frequent attendance to hospitals with estimated £3.5bn annual cost to the NHS in England. The purpose of this paper is to evaluate the effect of the hospital in-reach team of the Leeds Addiction Unit (LAU) in reducing hospital service utilization in people with alcohol dependence.

This is a retrospective cohort study, with a mirror-image design. The authors included all patients who had wholly alcohol attributable admission(s) to Leeds Teaching NHS Hospitals Trust (LTHT) during a four-month period between January and April 2013 and received treatment from LAU. The primary outcome measures were changes in A and E attendance (A&E) attendances, number of hospital admissions and days spent in hospital between the three months before and after the LAU intervention.

During the four-month period, there were 1,711 wholly alcohol attributable admissions related to 1,145 patients. LAU saw 265 patients out of them 49 who had wholly alcohol attributable admissions engaged in treatment with LAU. Of those who engaged 33 (67.3 per cent) had fewer A&E attendances, 34 (69.4 per cent) had fewer admissions and 39 (80 per cent) spent fewer days in hospital in the three months after compared to three months before. There was a significant reduction in total number of hospital admissions (78 vs 41, mean=1.56 vs 0.82, p<0.001) and days spent in hospital (490 vs 146, mean=9.8 vs 2.92, p<0.001).

This mirror-image study suggests that an alcohol hospital in-reach team could be effective in reducing acute hospital service utilization by engaging with the frequent attenders with alcohol misuse complications.

This study of 216 congestive heart failure (CHF) patients at a large teaching hospital in south‐central Ontario was undertaken to determine whether the patients managed in an outpatient heart failure clinic used fewer hospital resources (as expressed in number of admissions, complexity of admission, and length of stay (LOS)) than a matched cohort who were not managed in an outpatient clinic. Statistical significance of LOS opportunities could not be demonstrated (owing to sample size), however, the heart failure clinic is making a positive impact on all types of admissions (CHF and non‐CHF) in terms of LOS and suggests that management in an outpatient setting for chronic disease states is important for acute care hospitals to consider.

Describes an audit of inter‐profession communications among hospital, community health and social services concerning hospital admission. Information from 150 patient admissions (50 from each of three general practices after a target date) was gathered from both community and hospital sources. The results were used to audit the transfer policy operated by Airedale NHS Trust. The audit design incorporated an element of research, the results of which were used to inform the interpretation of the audit results and to suggest appropriate recommendations for change. Recommendations included the introduction of a pre‐admissions checklist, specific changes to the nursing documentation, measures to improve the speed of information transfer, and the clarification of responsibilities for initiating contact across the hospital‐community interface when patients with existing contacts in community services are admitted to hospital. Concludes that the introduction of supplementary research to an otherwise traditional audit cycle strengthened the resulting recommendations.

This study examined the personal characteristics and social context of two groups of women with learning disabilities and psychiatric disorders who resided in some form of community residential facility. One group of women had been admitted to hospital in the past 12 months (N = 20) and the other had been maintained in the community without any admissions (N = 33). A prospective natural group comparison design was employed over a 12‐month period to study any differences between the groups. Data was collected from the women's key workers using a pro forma and three standardised instruments: Index of Social Competence, Aberrant Behaviour Checklist and the PAS‐ADD Checklist. The groups were matched on age and level of learning disabilities. Differences were found between the groups' behavioural and psychiatric profiles. Anti‐psychotic medication was the first line of treatment. A non‐significant trend was found on negative life experiences, and a binary logistic regression analysis confirmed that high levels of challenging behaviour and having behavioural/mental health management strategies in place predicted hospital admission. The findings of this study are discussed and improvements are explored.

Against a background of an ageing population, rising emergency admissions and a policy direction moving towards providing care in the least intensive setting, this paper presents the dramatic results achieved in a 22‐week pilot of undivided health and social care replicating the Castlefields study and using Unique Care principles. In the context of practice‐based commissioning, where GP practices develop and commission services that represent the best model of care and use of resources for their patients, the potential for creating savings from this approach are discussed.

The purpose of this paper is to determine the incidence of the use of section 135(1) of the Mental Health Act 1983 in a London borough and describe the main features of the population subject to that section.

Uses of section 135(1), hospital stay, and demographic data were gathered from service and patient records over one year. Means, medians, modes and standard deviation were calculated for interval data. Nominal data were cross-tabulated and the chi square test applied where appropriate. Study data were compared to census and national hospital data; the significance of proportional population differences were calculated using the Z-test.

In total, 63 uses of section 135(1) were recorded. It was primarily used with people with psychotic diagnoses (79 per cent), and was used predominantly in black populations, and among people aged 40-54. People admitted to hospital after section 135(1) use who had psychosis diagnoses had median spells in hospital that were double the corresponding national median.

Total uses of section 135(1) in the borough equated to 25 per cent of the national total for all section 135 admissions recorded in 2012/2013. Hospital statistics in England focusing on admissions alone may fail to reflect a more widespread use of this section. Further research is required to confirm and develop the findings of this small scale study.

The repeated use of this section is suggested as a marker for reviewing practice and resource allocation to prevent or shorten hospital admissions for people with psychosis diagnoses.

This paper highlights gaps in NHS data collection in England relevant to policy makers, mental health service providers, and the police service.