Examining the length of hospital stay and associated factors in adult patients with schizophrenia

Background: Inpatient care is a key driver of mental healthcare costs in South Africa (SA). Schizophrenia is a common psychiatric diagnosis amongst hospitalised patients in the public sector of SA. Determining the length of stay (LOS) and associated factors in patients with schizophrenia could assist in effective utilisation of the mental healthcare budget. Aim: To determine the LOS and any associated socio-demographic and clinical factors in patients with schizophrenia. Setting: A psychiatric unit in a central public hospital, Chris Hani Baragwanath Academic Hospital (CHBAH) and a specialised psychiatric hospital, Tara H Moross (TARA) in Gauteng, SA. Methods: A quantitative retrospective review of the records of patients with schizophrenia admitted to CHBAH and discharged from CHBAH and TARA hospital over the study period was conducted. Information on the LOS, socio-demographic and clinical factors was collected upon discharge. Results: The median LOS for the 132 patients with schizophrenia was 42 days, with a mean of 55 days. In bivariate analysis, statistically significant factors associated with LOS were living arrangements (p = 0.036), number of previous admissions (first admission) (p = 0.009) and being on clozapine (p 0.001). However, in regression analyses, only living alone remained statistically significant and associated with a shorter LOS (p = 0.004). Conclusion: Prolonged LOS indicates ongoing reliance on inpatient care due to service level constraints, including poorly resourced community psychiatric services and individual contextual factors. Both socio-demographic and clinical factors influenced LOS. Associated factors such as living alone and early clozapine initiation provide targets from which to start addressing modifiable contributors that may reduce LOS. Contribution: This study contributes to the limited data on the LOS for patients with schizophrenia in SA.