In 1989 Johns Hopkins Hospital modified the Meyer 3 short-stay
psychiatric service, which has allowed the hospital to comply with state
requirements to control inpatient costs and has increased revenues.
Strategies and organizational changes that were implemented to reduce
length of stay include use of a screening tool by the admitting physician
to ensure appropriate referrals to the service, modification of morning and
afternoon rounds and strengthening of linkages with the psychiatric
emergency department and outpatient services to enhance communication,
replacement of inexperienced first- year residents in the emergency
department with senior residents on 24- hour call who are closely
supervised by short-stay service staff, and enhanced training for service
nurses. Patients who are functionally disabled and who need assistance in
activities of daily living have longer stays. Patients with substance use
disorders are now referred to an ultra-short-stay unit.