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The Bed Requirement Inventory: A Simple Measure To Estimate The Need For A Psychiatric Bed

Tyrer, Department of Psychological Medicine, Imperial College (Charing Cross Campus), ClaybrookCentre, London, UK.

Geetha Suryanarayan

Central North West London Mental Health NHS Trust, Paterson Centre, London, UK. Ms Bharti Rao, Department of Psychological Medicine, Imperial College (Charing Cross Campus), Claybrook Centre, London, UK.

Bharti Rao

Department of Psychological Medicine, Imperial College(Charing Cross Campus), Claybrook Centre, London, UK.

Domenic Cicchetti

Department of Psychological Medicine, Imperial College (Charing Cross Campus), Claybrook Centre, London, UK.

Naomi Fulop

Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK. John Green

Fiona Roberts

Department of Psychological Medicine, Imperial College (Charing Cross Campus), Claybrook Centre, London, UK.

Jeremy Slaughter

Department of Psychological Medicine, Imperial College (Charing Cross Campus), Claybrook Centre, London, UK.

Objective: To develop an assessment of bed need that was as little affected by personal biasas possible. Method: The Bed Requirement Inventory (BRI) is an eight-point scale designed to identify the appropriate use of an acute psychiatric bed. This is completed by a member of the ward staff, usually a nurse, and takes 5 minutes to fill in. The reliability, validity and feasibility of using the scale in normal practice were tested in a one-year study, and variations ininappropriate bed use described. Results: The inter-rater reliability of the scale was good (intra-class correlation coefficient = 0.63) and a comparison of the need for a psychiatric bed (comparing the BRI score with the judgement of an independent multidisciplinary group of professionals) also showed good agreement (k ¹/4 0.69), suggesting reasonable validity (although when the assessment was made by the named nurse agreement was less good). Results from a year-long survey in two West London hospitals showed that 17% of admissions were inappropriate and 32% had delayed discharge, black Caribbean patients had a significantly higher proportion (25%) of inappropriate admission than others (11%) and those referred from housing charities andhostels had a higher proportion (50%) of inappropriate bed use at some time than other groups(33%). Conclusions: The Bed Requirement Inventory is a quick and reliable method of determiningthe appropriate use of a psychiatric bed and could be of use in estimating local bed needs. Delayeddischarge remains a serious reason for inappropriate bed use in London.

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