• R M Steel and I M McKay.
• Edinburgh University Department of Psychiatry, Royal Edinburgh Hospital, Morningside Park, Edinburgh.
• Health Bull (Edinb). 2000 Mar 1; 58 (2): 112-7.

ObjectiveTo examine routes of admission to psychiatric beds and to identify factors that influence this.DesignRetrospective casenote study.SettingsAcute adult psychiatric wards in South Glasgow.SubjectsOne hundred consecutive admissions over a one month period.ResultsThere were twelve discrete sources of referral. Psychiatrists and Community Psychiatric Nurses (CPNs) together accounted for 32% of referrals and General Practitioners for 25%. Schizophreniform and mood disorders affected 34% and 31% of the patients respectively whilst 25% of those admitted were deemed to have no major mental illness. Twenty-seven percent of patients were admitted to an inappropriate ward because the appropriate ward was full: personality disorders and drug problems were statistically significantly over represented amongst these "boarders". Over 80% of patients were admitted by the on-call psychiatric SHO rather than by a doctor from their own team. Only 32% of admissions occurred during office hours. Psychiatrists and CPNs were significantly less reliant upon emergency admission procedures than were other referrers. The pathway to admission was independent of patient's sex, diagnosis, legal status, previous contact with services and of ward location. Community-based psychiatrists and CPNs admitted relatively fewer patients with schizophrenia than did their hospital-based colleagues.ConclusionPatients are referred for admission to acute psychiatric wards from a variety of sources. Most admissions occur outwith office hours. In a large majority of cases the admitting psychiatrist is the on-call SHO, rather than a doctor from the team responsible for the patient's management. Our data suggest that this is not a reflection of the type of cases referred for urgent assessment but rather a failure of certain aspects of service provision.

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