Question

This systematic review1 was an update to a prior systematic review designed to evaluate the effect of short or brief admissions (defined as less than 28 days) to hospital care for persons with serious mental illness, compared with longer-stay hospital admissions.

Relevance to nursing care

This systematic review has relevance for nurses who serve as advocates for persons with serious mental illness, support systems for individuals who care for those with mental illness and champions for health policies that support optimal recovery from mental illness in a humane treatment setting.

Study characteristics

This systematic review is an update of a previously completed systematic review. The update did not identify any additional studies meeting the stated inclusion criteria since the completion of the original systematic review. The search for this review was completed in May of 2012. The initial database search identified 477 records; however, after corrections for duplication, review for relevance and assessment of methodological quality, only six studies were included in the final quantitative systematic review. Six relevant randomized trials were identified and included; however, each of these trials is quite dated (completed between 1969 and 1980). The review is also compromised by the assessment of all the included studies as being of either low or very low quality. This assessment lessens the ability of the review conclusions to have valid impact on health policy. Data were extracted independently as dichotomous data with calculated risk ratios, 95% confidence intervals (CI), an intention-to-treat basis and utilizing a fixed-effects model. The risk for bias and the quality of the evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). The review results indicated no significant difference in death, improvement in mental state, hospital readmission, study attrition or loss to follow-up. There were, however, significant differences in social functioning including likelihood of employment (favoured those with a short stay; risk ratio 0.61, 95% CI 0.50-0.76) and delayed discharge (delay less likely for those with a short stay; risk ratio 0.54, 95% CI 0.33-0.88). Limited information in the review indicated that shorter hospitalizations do not encourage a 'revolving door' effect or a lack of care continuity. The plain language summary of this review was written by a mental health care consumer who serves as a Service User Expert in the United Kingdom. This inclusion of a mental health consumer in the dissemination of this systematic review is particularly laudable.

Implications for nursing care

A primary role for nurses, particularly those caring for persons with serious mental illness, is the role of patient advocate. The implications of this systematic review give nurses evidence upon which they can reassure patients who are treated with shorter-length hospitalizations that their likelihood of recovery is not harmed by a shorter inpatient care episode. Likewise, this information may provide reassurance and confidence for the individuals who care for persons with serious mental illness. Perhaps of equal importance is the implication of nurses having greater confidence when providing care in settings using inpatient lengths of stay less than 28 days.

Implications for research

The paucity of research studies that could be included in this review, as well as the poor quality of the included reviews, leads to a call for future research on this issue and related topics. Specifically, future studies should address the following issues:

1. Increased quantity and improved quality of research studies on this topic

2. Replication of high quality studies to provide adequate data upon which future systematic reviews can be based

3. Research focused on significant outcomes such as:DeathSelf-harmHarm to othersEmploymentCriminal behaviourMental statePatient satisfactionHomelessnessSocial and/or family relationshipsEconomic impact

Reference