Rapid Versus Standard Clozapine Titration Orders in a Psychiatric Acute Inpatient Facility

Abstract

Objective: The aim of this study is to evaluate if rapid versus standard clozapine titration is associated with reduced length of stay (LOS) for treatment resistant psychiatric inpatients. Methods: This retrospective chart review study collected socio-demographics and clinical outcomes of psychiatric inpatients with clozapine order sets, including primary diagnosis, order initiation date, discharge readiness and post-discharge placement. An electronic health record report of psychiatric inpatients with clozapine orders between September 2016 and April 2018 yielded 93 separate admissions receiving either rapid titration protocol (RTP) or standard titration (STP) based upon the physician preference. Results: Of the 93 patients who were prescribed clozapine, 37 were started on the RTP and 56 were on the STP. The primary diagnosis of patients in both RTP and STP groups was Schizoaffective disorder at 78.38% and 62.5%, respectively. The median discharge ready (DCR) days were in fact lower for RTP than STP inpatients, although this was not statistically significant. Conclusion: Ultimately, it was determined that the median LOS was similar between patients on rapid and standard titrations.