How to Use Borderline Personality Disorder Length-of-Stay Findings in Discharge Planning
How should clinicians use this study's inpatient length-of-stay findings when planning discharge for patients admitted with borderline personality disorder?
Clinicians often need to decide how to frame risk and next steps after inpatient admission for borderline personality disorder. In Recurrent Mental Health Presentations to Public Hospital Services: A Focus on Borderline Personality Disorder, longer initial inpatient stays were not linked to a longer time before return to hospital, and stays longer than 14 days were associated with earlier re-presentation than stays under 2 days.
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Classify the initial inpatient stay into the study's length-of-stay groups
When interpreting the article's findings for an admitted patient with borderline personality disorder, place the first inpatient stay into 1 of the study's 4 categories: less than 2 days, 2 to 7 days, 8 to 14 days, or more than 14 days. These were the exact cut-points used for the exploratory length-of-stay analysis. Using the same categories helps align bedside interpretation with the data actually reported.
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Estimate the expected timing of return based on the reported group means
For patients with borderline personality disorder, the mean time to a second emergency department and/or inpatient presentation was 199 days after a stay under 2 days, 179 days after a stay of 2 to 7 days, 179 days after a stay of 8 to 14 days, and 142 days after a stay longer than 14 days. These values indicate that longer admission did not produce a longer interval before return in this cohort. Use these figures to avoid assuming that a prolonged admission is protective against near-term re-presentation.
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Interpret stays longer than 14 days as a higher-concern signal rather than reassurance
The only statistically significant pairwise contrast was between more than 14 days and less than 2 days. In that comparison, the mean time to second hospital presentation was 58 days sooner for the more-than-14-day group, with P = .036. For discharge planning, this means a prolonged first admission should not be used as reassurance that repeat presentation risk has been reduced.
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Avoid overinterpreting non-significant contrasts between the intermediate groups
No other pairwise comparisons among the borderline personality disorder length-of-stay groups were statistically significant. That means the article does not support a finer-grained clinical rule favoring 2 to 7 days over 8 to 14 days, or either of those over under 2 days, based on re-presentation timing alone. Restrict interpretation to what the study actually demonstrated.
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Apply these findings specifically to borderline personality disorder rather than all personality disorders
The observed length-of-stay pattern was not replicated in patients with other personality disorders. In that group, mean time to second hospital visit ranged from 199 to 213 days, and there were no statistically significant pairwise differences. Use the article's length-of-stay signal as specific to borderline personality disorder within this dataset.
Clinical Considerations
- The length-of-stay analysis was exploratory and based on observational data, so it does not establish that longer stays cause earlier return to hospital.
- The authors note that inpatient admission is not generally recommended as a primary treatment for borderline personality disorder, although it may at times be necessary.
- The dataset could not account for several potentially important confounders, including ethnicity, education, social support, unemployment, and homelessness.
- The findings describe public hospitals in South Australia and may not fully generalize to other health systems or private-sector care.
Bottom Line
For borderline personality disorder, a first inpatient stay longer than 14 days was associated with earlier, not later, return to hospital compared with a stay under 2 days.
