1
|
Lindkvist RM, Steen Carlsson K, Daukantaitė D, Flyckt L, Westling S. Brief admission by self-referral as an add-on to usual care for individuals with self-harm at risk of suicide: cost-effectiveness and 4-year health-economic consequences after a Swedish randomized controlled trial. Nord J Psychiatry 2024; 78:497-506. [PMID: 38875018 DOI: 10.1080/08039488.2024.2366854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/06/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Brief Admission by self-referral (BA) is a crisis-management intervention standardized for individuals with self-harm at risk of suicide. We analyzed its health-economic consequences. MATERIALS AND METHODS BA plus treatment as usual (TAU) was compared with TAU alone in a 12-month randomized controlled trial with 117 participants regarding costs for hospital admissions, coercive measures, emergency care and health outcomes (quality-adjusted life years; QALYs). Participants were followed from 12 months before baseline to up to five years after. RESULTS Over one year BA was associated with a mean annual cost reduction of 4800 or incremental cost of 4600 euros, depending on bed occupancy assumption. Cost-savings were greatest for individuals with >180 admission days in the year before baseline. In terms of health outcomes BA was associated with a QALY gain of 0.078. Uncertainty analyses indicated a significant QALY gain and ambiguity in costs, resulting in BA either dominating TAU or costing 59 000 euros per gained QALY. CONCLUSION BA is likely to produce QALY gains for individuals living with self-harm and suicidality. Cost-effectiveness depends on targeting high-need individuals and comparable bed utilization between BA and other psychiatric admissions. Future research should elaborate the explanatory factors for individual variations in the usage and benefit of BA.
Collapse
Affiliation(s)
- Rose-Marie Lindkvist
- Department of Clinical Sciences Malmö, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
| | - Katarina Steen Carlsson
- Department of Clinical Sciences, Malmö, Health Economics, Lund University, Malmö, Lund, Sweden
| | | | - Lena Flyckt
- Centre for Psychiatric Research, Dept. of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Sofie Westling
- Department of Clinical Sciences Malmö, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden, Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Malmö, Sweden
| |
Collapse
|
2
|
Maddineshat M, Khodaveisi M, Kamyari N, Razavi M, Pourmoradi F, Sadeghian E. Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed-methods study. J Psychiatr Ment Health Nurs 2024; 31:257-269. [PMID: 37740710 DOI: 10.1111/jpm.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION Previous research has indicated that community-based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards. AIM This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran. METHOD An explanatory mixed-methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi-structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis. RESULTS The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper-vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'. DISCUSSION MHNs employ a hyper-vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance. IMPLICATIONS FOR MENTAL HEALTH NURSING According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards.
Collapse
Affiliation(s)
- Maryam Maddineshat
- Department of Nursing, School of Malayer Nursing, Student Research Committee, Chronic Disease (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Khodaveisi
- Department of Community Health Nursing, School of Nursing and Midwifery, Chronic Disease (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Naser Kamyari
- Department of Biostatistics and Epidemiology, School of Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Mohammadreza Razavi
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Farnaz Pourmoradi
- Sina (Farchian) Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Efat Sadeghian
- Department of Nursing, School of Nursing and Midwifery, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
3
|
Svensson J. Exploring patient safety risk in an emergency ward for substance use through a mixed-method analysis. BMC Health Serv Res 2024; 24:153. [PMID: 38297311 PMCID: PMC10832160 DOI: 10.1186/s12913-024-10621-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/20/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND There is limited knowledge of how psychiatric patient safety measures can detect and understand risk as an emergent property within a healthcare system. Overcrowding poses a risk for patient safety in psychiatric emergency wards and is associated with increased mortality and violence. This paper aims to explore patterns of risk emergence in a psychiatric ward and provide insights into the dynamics of workload pressure. METHOD A case study was conducted in a psychiatric emergency ward for patients with substance use disorders. The study employed a four-phased mixed-methods design. Phase one used clinical experts to identify patient safety pressure issues. Phase two used data on patient visits extracted from medical records between 2010 and 2020. In phase three, a quantitative analysis of patient visits and diagnosis was made. Phase four used a focus group of clinical experts for a semi-structured interview, analysing the result from phase three. RESULT Trend analysis demonstrated a steady growth of patient visits to the emergency ward over the studied ten-year period. The findings showed a decrease in patients being diagnosed with delirium when visiting the emergency ward and an increase in percentage of patients receiving a psychosis diagnosis. The focus group expressed concerns about delayed treatments, increased violence and underestimating patients' needs. CONCLUSION This study indicated that increased workload pressure can be predicted at a system level by analysing patient visits and diagnostics trends over time. The study advocates for ongoing awareness of patient safety risks by monitoring factors identified by clinical front-end workers as potential sources of risk. Healthcare management could employ supportive tools to detect and address emerging risks, including expected workload, overcrowding, staffing issues or bed shortages.
Collapse
Affiliation(s)
- Jakob Svensson
- Division of Risk Management and Societal Safety, Lund University, Box 118, Lund, SE-22100, Sweden.
| |
Collapse
|
4
|
Miodownik C, Friger MD, Teitelbaum A, Demchuk N, Zhuk A, Agababa T, Sokolik S, Lerner PP, Calfon N, Lerner V. Risk factors for coercion length at psychiatric hospitals in Israel: Relationship with staff. Indian J Psychiatry 2024; 66:36-42. [PMID: 38419935 PMCID: PMC10898533 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_814_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 06/27/2023] [Accepted: 11/11/2023] [Indexed: 03/02/2024] Open
Abstract
Background Coercive interventions continue to be applied frequently in psychiatric care when patients are at imminent risk of harming themselves and/or others. Aim The purpose of this study was to demonstrate the relationship between the length of coercion and a variety of factors, including the sociodemographic background of patients, their diagnoses and the characteristics of hospital staff. Methods This is a one-year cross-sectional retrospective study, including records of 298 patients who underwent restraint and/or seclusion interventions in male acute, closed wards in two psychiatric hospitals in Israel. Results A higher proportion of academic nurses to nonacademic nurses on duty leads to a shorter coercion time (P < 0.000). The number of male staff on duty, without any relation to their level of education, also leads to the shortening of the coercion time. Conclusion The presence of registered, academic female nurses, male staff on duty and the administration of medication before coercive measures can reduce the length of restriction.
Collapse
Affiliation(s)
- Chanoch Miodownik
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Michael D. Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | - Natalya Demchuk
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | - Tsipora Agababa
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Shmuel Sokolik
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | | | - Vladimir Lerner
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| |
Collapse
|
5
|
Akram S, Sah Swarnakar A, Lodeiro M, Jalil A, Majeed A, Mukhtar F, Akram F. Impact of COVID-19-Related Social Distancing on the Incidence of Inpatient Aggression at a Public Psychiatric Hospital. Cureus 2023; 15:e49440. [PMID: 38149167 PMCID: PMC10750845 DOI: 10.7759/cureus.49440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE This study explores the impact of coronavirus disease (COVID) pandemic-related social distancing measures on the incidence of inpatient aggression at a public psychiatric hospital Methods: Data was gathered from the hospital's unusual incident (UI) database for the time period ranging from January 1, 2015, to December 31, 2020. Based on the implementation of major social distancing measures, March 6, 2020, was set as a cutoff time point to categorize aggressive events into pre-COVID and post-COVID groups. Data was analyzed using Chi-square tests and general linear modeling. The p-value was set at ≤0.05. RESULTS After the implementation of social distancing measures, there was a decrease in the absolute number of inpatient aggressive events from 15.0/week to 12.6/week (mean difference: 2.4/week, p=0.032). However, this decrease was primarily attributable to a decrease in hospital census. There was a decrease in the proportion of seven-day and 14-day post-admission aggressive events by 5.4% and 12.1%, respectively. Concurrently, there was a 4.9% increase in recurrent aggression. Emergency psychiatric medication administration and the use of physical restraint decreased during the COVID-19 pandemic. CONCLUSION Consistent with previous results, this study reports a decrease in the incidence of inpatient aggression during the COVID-19 pandemic. Social distancing measures can be utilized as a tool to decrease the incidence of inpatient aggression and the use of physical restraints.
Collapse
Affiliation(s)
- Salman Akram
- Psychiatry and Behavioral Sciences, Saint Elizabeths Hospital, Washington, USA
| | | | - Madeline Lodeiro
- Psychiatry and Behavioral Sciences, Saint Elizabeths Hospital, Washington, USA
| | - Ahmad Jalil
- Internal Medicine, Mayo Hospital, Jacksonville, USA
| | - Aleena Majeed
- Psychiatry, Fatima Jinnah Medical University, Lahore, PAK
| | - Fahad Mukhtar
- Psychiatry and Behavioral Sciences, Sheppard Pratt Hospital, Baltimore, USA
| | - Faisal Akram
- Psychiatry and Behavioral Sciences, Saint Elizabeths Hospital, Washington, USA
- Psychiatry, Mindpath Health, Oakland, USA
| |
Collapse
|
6
|
Argo D, Daibas K, Barash I, Abramowitz MZ. A 10-year comparison of short versus long-term court-ordered psychiatric hospitalization: a follow-up study. Isr J Health Policy Res 2023; 12:14. [PMID: 37081457 PMCID: PMC10120128 DOI: 10.1186/s13584-023-00561-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/01/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The Israel Mental Health Act of 1991 stipulates a process for court-ordered involuntary psychiatric hospitalization. As in many Western countries, this process is initiated when an individual is deemed "not criminally responsible by reason of mental disorder (NCR-MD)" or "incompetent to stand trial (IST)." A patient thus hospitalized may be discharged by the district psychiatric committee (DPC). The decision rendered by the DPC is guided by an amendment to the Mental Health Act that states that the length of the hospitalization should be in accordance with the maximum time of incarceration associated with the alleged crime. Little empirical research has been devoted to the psychiatric, medical, and social outcome of short versus long-term hospitalization under court order. METHODS In our study we examined the outcomes of court-ordered criminal commitments over a 10-year period (2005-2015) at the Jerusalem Mental Health Center with a catchment area of 1.5 million. We found 136 cases (between the ages of 18 and 60) of criminal commitments during that period and used the average length of hospitalization, 205 days, as a cutoff point between short and long stays. We compared the outcomes of short and long hospitalizations of discharged patients using a follow-up phone survey (at least 7 years post-discharge) and data extracted from the Israel National Register to include recidivism, patient satisfaction and trust in the system, readmission, and demise. RESULTS We found no statistically significant difference between short-term and long-term hospitalizations for reducing instances of re-hospitalization (p = 0.889) and recidivism (p = 0.54), although there was a slight trend toward short-term hospitalization vis-à-vis reduced recidivism. We did not find a statistical difference in mortality or incidents of suicide between the two groups, but the absolute numbers are higher than expected in both of them. Moreover, our survey showed that short-term hospitalization inspired more trust in the legal process (conduct of the DPC), in pharmacological treatment satisfaction, and in understanding the NCR-MD as a step toward avoiding future hospitalization and that it resulted in a higher level of patient satisfaction. CONCLUSIONS The results we present show that as far as recidivism and readmission are concerned, there is no evidence to suggest that there is an advantage to long-term hospitalization. Although there may be unmeasured variables not investigated in the present study that might have contributed to the discrepancy between long- and short-term hospitalization, we believe that longer hospitalizations may not serve the intended treatment purpose. Additionally, the high cost of long-term hospitalization and overcrowded wards are obviously major practical drawbacks. The impact of the clinical outcomes should be reflected in medico-legal legislation and in court-ordered hospitalization in particular.
Collapse
Affiliation(s)
- Daniel Argo
- Jerusalem Mental Health Center, Eitanim Psychiatric Hospital, Jerusalem, Israel.
- Hebrew University-Hadassah School of Medicine, Jerusalem, Israel.
| | | | - Igor Barash
- Jerusalem Mental Health Center, Eitanim Psychiatric Hospital, Jerusalem, Israel
| | - Moshe Z Abramowitz
- Peres Academic Center, Rehovot, Israel
- Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| |
Collapse
|
7
|
Jansen TL, Danbolt LJ, Hanssen I, Hem MH. How may cultural and political ideals cause moral distress in acute psychiatry? A qualitative study. BMC Psychiatry 2022; 22:212. [PMID: 35321674 PMCID: PMC8944013 DOI: 10.1186/s12888-022-03832-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is growing public criticism of the use of restraints or coercion. Demands for strengthened patient participation and prevention of coercive measures in mental health care has become a priority for care professionals, researchers, and policymakers in Norway, as in many other countries. We have studied in what ways this current ideal of reducing the use of restraints or coercion and attempting to practice in a least restrictive manner may raise morals issues and create experiences of moral distress in nurses working in acute psychiatric contexts. METHODS Qualitative interview study, individual and focus group interviews, with altogether 30 nurses working in acute psychiatric wards in two mental health hospitals in Norway. Interviews were recorded and transcribed. A thematic analytic approach was chosen. RESULTS While nurses sense a strong expectation to minimise the use of restraints/coercion, patients on acute psychiatric wards are being increasingly ill with a greater tendency to violence. This creates moral doubt and dilemmas regarding how much nurses should endure on their own and their patients' behalf and may expose patients and healthcare personnel to greater risk of violence. Nurses worry that new legislation and ideals may prevent acutely mentally ill and vulnerable patients from receiving the treatment they need as well as their ability to create a psychological safe climate on the ward. Furthermore, persuading the patient to stay on the ward can cause guilt and uneasiness. Inadequate resources function as external constraints that may frustrate nurses from realising the treatment ideals set before them. CONCLUSIONS Mental health nurses working in acute psychiatric care are involved in a complex interplay between political and professional ideals to reduce the use of coercion while being responsible for the safety of both patients and staff as well as creating a therapeutic atmosphere. External constraints like inadequate resources may furthermore hinder the healthcare workers/nurses from realising the treatment ideals set before them. Caught in the middle nurses may experience moral distress that may lead to physical discomfort, uneasiness and feelings of guilt, shame, and defeat. Pressure on nurses and care providers to reduce or eliminate the use of coercion and reduction of health care spending are incompatible demands.
Collapse
Affiliation(s)
- Trine-Lise Jansen
- Norway, MF Norwegian School of Theology, Religion and Society, Lovisenberg Diakonale Høgskole (Lovisenberg Diaconal University College), Oslo, Norway.
| | | | - Ingrid Hanssen
- Lovisenberg Diakonale Høgskole (Lovisenberg Diaconal University College), Oslo, Norway
| | | |
Collapse
|
8
|
Stathopoulos D, Ekvall Hansson E, Stigmar K. Exploring the Environment behind In-Patient Falls and Their Relation to Hospital Overcrowdedness-A Register-Based Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10742. [PMID: 34682482 PMCID: PMC8535502 DOI: 10.3390/ijerph182010742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: Inpatient falls are a serious threat to patients' safety and their extrinsic factors are, at present, insufficiently described. Additionally, hospital overcrowdedness is known for its malicious effects but its relation to the inpatient falls is currently underexplored. The aim of this study was to explore the distribution of falls and their extrinsic characteristics amongst a range of different clinics, and to explore the correlation and predictive ability of hospital overcrowding in relation to inpatient falls. (2) Methods: An observational, cross-sectional, registry-based study was conducted using retrospective data from an incidence registry of a hospital organization in Sweden during 2018. The registry provided data regarding the extrinsic factors of inpatient falls, including the clinics' overcrowdedness. Simple descriptive statistics, correlation analysis and simple linear regression analysis were used. (3) Results: Twelve clinics were included. A total of 870 inpatient falls were registered during 2018. Overcrowdedness and total amount of falls were positively and very strongly correlated (r = 0.875, p < 0.001). Overcrowdedness was a significant predictor of the total amount of inpatient falls (p < 0.001, α = 0.05). (4) Conclusions: The characteristics regarding inpatient falls vary among the clinics. Inpatient overcrowding might have a significant role in the prevalence of inpatient falls, but further high-evidence-level studies are required.
Collapse
Affiliation(s)
| | - Eva Ekvall Hansson
- Department of Health Sciences, Lund University, 22100 Lund, Sweden; (D.S.); (K.S.)
| | | |
Collapse
|
9
|
Weltens I, Bak M, Verhagen S, Vandenberk E, Domen P, van Amelsvoort T, Drukker M. Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature. PLoS One 2021; 16:e0258346. [PMID: 34624057 PMCID: PMC8500453 DOI: 10.1371/journal.pone.0258346] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/26/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION On psychiatric wards, aggressive behaviour displayed by patients is common and problematic. Understanding factors associated with the development of aggression offers possibilities for prevention and targeted interventions. This review discusses factors that contribute to the development of aggression on psychiatric wards. METHOD In Pubmed and Embase, a search was performed aimed at: prevalence data, ward characteristics, patient and staff factors that are associated with aggressive behaviour and from this search 146 studies were included. RESULTS The prevalence of aggressive behaviour on psychiatric wards varied (8-76%). Explanatory factors of aggressive behaviour were subdivided into patient, staff and ward factors. Patient risk factors were diagnosis of psychotic disorder or bipolar disorder, substance abuse, a history of aggression, younger age. Staff risk factors included male gender, unqualified or temporary staff, job strain, dissatisfaction with the job or management, burn-out and quality of the interaction between patients and staff. Staff protective factors were a good functioning team, good leadership and being involved in treatment decisions. Significant ward risk factors were a higher bed occupancy, busy places on the ward, walking rounds, an unsafe environment, a restrictive environment, lack of structure in the day, smoking and lack of privacy. CONCLUSION Despite a lack of prospective quantitative data, results did show that aggression arises from a combination of patient factors, staff factors and ward factors. Patient factors were studied most often, however, besides treatment, offering the least possibilities in prevention of aggression development. Future studies should focus more on the earlier stages of aggression such as agitation and on factors that are better suited for preventing aggression such as ward and staff factors. Management and clinicians could adapt staffing and ward in line with these results.
Collapse
Affiliation(s)
- Irene Weltens
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Simone Verhagen
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Emma Vandenberk
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Patrick Domen
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
10
|
Knudsen SV, Hermansen SB, Holmskov J, Johnsen SP, Mainz J. Patient Inventory: a quality improvement method. Int J Qual Health Care 2021; 32:300-305. [PMID: 32412058 DOI: 10.1093/intqhc/mzaa038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/16/2020] [Accepted: 04/03/2020] [Indexed: 11/14/2022] Open
Abstract
Providing high quality care requires that patient care pathways are organized according to the needs of the patient. The organization of high-quality integrated patient care requires methods to assess 'appropriateness' of the care pathways to identify challenges in delivering the right procedure, for the right person at the right time and setting and with the most appropriate use of resources. There is a need for methods to assess appropriateness that can easily be implemented in daily clinical practice. The Patient Inventory method is such a method. Patient Inventory is a special type of audit that provides a 'snapshot' of the patient population in an entire hospital, a ward or another clinical unit. It maps the bed occupancy situation, as well as coordination, continuity and communication associated with the individual patient pathway. The aim is to identify inappropriate or wasteful events and to facilitate reflections on the underlying causes. These reflections are used to identify focus areas for quality improvement efforts. The method answers the question: 'Is it the right patient in the right place at the right time, and is the correct pathway for the patient organized with the most appropriate use of resources?' The aim of this method paper is to describe the background, definitions and methodologies for Patient Inventory, to offer a practical guidance for application of the method and to describe the current experiences with the method.
Collapse
Affiliation(s)
- Søren Valgreen Knudsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark.,Psychiatric Management, Psychiatry in Region North Jutland, North Denmark Region, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Sabina Bay Hermansen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Jens Holmskov
- Psychiatric Management, Psychiatry in Region North Jutland, North Denmark Region, Mølleparkvej 10, 9000 Aalborg, Denmark.,Department of Psychiatry, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Jan Mainz
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark.,Psychiatric Management, Psychiatry in Region North Jutland, North Denmark Region, Mølleparkvej 10, 9000 Aalborg, Denmark.,Department of Health Economics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.,Department for Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel
| |
Collapse
|
11
|
Crowded and popular: The two sides of the coin affecting theme-park experience, satisfaction, and loyalty. JOURNAL OF DESTINATION MARKETING & MANAGEMENT 2020; 18:100468. [PMCID: PMC7485498 DOI: 10.1016/j.jdmm.2020.100468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 05/22/2023]
Abstract
Crowding has become popular in academic research. Empirical studies have not, however, addressed the role of crowding on increasingly popular theme-park settings. This study explores the relative influences of perceived crowding and perceived popularity on theme-park product perceptions, which then influence satisfaction and behavioral intentions. Survey data (N=477) indicates that perceived crowding has a negative effect on internal access (or navigation) of the theme-park experience, while perceived popularity has positive effects on internal access, outdoor entertainment, and retail practices aspects of the theme-park overall experiences. These aspects of theme-park experiences have significant influences on visitors’ satisfaction, which then affect behavioral intentions of word-of-mouth, willingness to pay price premiums, and revisit. The external access aspect of theme-park experiences is not influenced by either crowding or popularity, and this aspect does not influence satisfaction either. The theoretical and managerial implications of the study are critical, especially for recovery efforts post COVID-19. Explores the influences of perceived crowding and popularity on theme park experience. Analyzes the impact of theme park experience on satisfaction and behavioral intentions. Perceives crowding has a negative effect on internal navigation within the theme park. Perceived popularity has positive effects on navigation, entertainment and retail. These experiences have significant influences on visitors' satisfaction and loyalty. Theoretical and managerial implications are critical for COVID-19 recovery efforts.
Collapse
|
12
|
Hermansen SB, Holmskov J, Johnsen SP, Mainz J, Knudsen SV. Quality in practice: applying the patient inventory method at a Danish psychiatric hospital. Int J Qual Health Care 2020; 32:477-479. [PMID: 32696039 DOI: 10.1093/intqhc/mzaa076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/16/2020] [Accepted: 07/07/2020] [Indexed: 11/12/2022] Open
Abstract
QUALITY PROBLEM Patient care pathways should be organized according to the needs of the patients. This requires methods to assess whether the specific pathways ensure the right care for the right person at the right time and in the right setting. INITIAL ASSESSMENT Previous investigations indicate that ~25% of the patients in Danish hospitals experience inappropriate elements in their care pathways. CHOICE OF SOLUTION This study applied the Patient Inventory method to identify inappropriate elements in care pathways in 15 psychiatric in-patient wards in Denmark. IMPLEMENTATION The pathway for 201 patients was systematically evaluated by the clinical staff to identify whether the admission of the patient was avoidable, the hospitalization was unnecessarily prolonged or if the patient could receive more relevant treatment elsewhere. A subsequent meeting between the clinical staff and management qualified the assessment and identified possible solutions to problems. EVALUATION A total of 54 (26.9%) of the included patients were assessed to have inappropriate elements in their care pathways, some with more than one type, resulting in a total of 65 episodes.Eight of these episodes (13.1%) were admissions considered to be avoidable, 26 (42.2%) were unnecessary prolongation of admissions, and 31 (58.1%) were patients assessed to be able to receive more relevant care elsewhere. LESSONS LEARNED One out of four assessed patients admitted to a psychiatric ward was exposed to an inappropriate element in their care pathway. The Patient Inventory tool can assist in a structured dialogue between clinical staff and management to identify focus areas for improvement efforts.
Collapse
Affiliation(s)
- Sabina Bay Hermansen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University Hospital, Aalborg University, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Jens Holmskov
- Psychiatric Management, Psychiatry in Region North Denmark, Mølleparkvej 10, 9000 Aalborg, Denmark
- Department of Psychiatry, University of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University Hospital, Aalborg University, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Jan Mainz
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University Hospital, Aalborg University, Mølleparkvej 10, 9000 Aalborg, Denmark
- Psychiatric Management, Psychiatry in Region North Denmark, Mølleparkvej 10, 9000 Aalborg, Denmark
- Department of Health Economics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
- Department for Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel
| | - Søren Valgreen Knudsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University Hospital, Aalborg University, Mølleparkvej 10, 9000 Aalborg, Denmark
- Psychiatric Management, Psychiatry in Region North Denmark, Mølleparkvej 10, 9000 Aalborg, Denmark
| |
Collapse
|
13
|
Salzmann-Erikson M, Yifter L. Risk Factors and Triggers That May Result in Patient-Initiated Violence on Inpatient Psychiatric Units: An Integrative Review. Clin Nurs Res 2019; 29:504-520. [DOI: 10.1177/1054773818823333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the present integrative review is to identify and describe risk factors and triggers that may result in patient-initiated violence on inpatient psychiatric units. Original studies were searched for in PubMed, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature. From the 826 identified publications, 18 were included for a synthesis. The results are presented in three themes, which demonstrate that patient characteristics, staff approach, and the ward environment are influencers that may trigger the emergence of violent incidents. Incidents are discussed from the theoretical framework of complexity science as dynamic, highly variable in manifestation, and adaptive, in that the forthcoming process and outcomes are highly dependent on how the surrounding environment responds. Our recommendation is that staff on inpatient wards recognize the myriad influencers that may trigger inpatient violence in a context of highly complex interactions.
Collapse
|
14
|
Guaiana G, O'Reilly R, Grassi L. A Comparison of Inpatient Adult Psychiatric Services in Italy and Canada. Community Ment Health J 2019; 55:51-56. [PMID: 29725879 DOI: 10.1007/s10597-018-0283-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
Abstract
We examine the possibility the Organisation for Economic Co-operation and Development (OECD) bed count for Italy may be an underestimation of the actual beds available. We compared bedded services for mental disorders in two regions in Italy and Canada respectively. We found out that if we consider acute psychiatric beds only, the district of Ferrara has 30 beds (8.5 per 100,000) and the Middlesex and Elgin Counties have 89 beds (16.3 beds for 100,000). However, if we include the rehabilitation beds (that are located within a hospital setting in Ontario and in a residential community setting in Ferrara), we find that the district of Ferrara has 95 beds (27.0 per 100,000) and the Middlesex and Elgin Counties have 176 beds (32.3 per 100,000). As a result, the 10/100,000 beds rate for Italy reported by the OECD is an underestimate compared to figures reported for most other countries, as the beds included are hospital beds only.
Collapse
Affiliation(s)
- Giuseppe Guaiana
- Departments of Psychiatry and Epidemiology & Biostatistics, Western University, St. Thomas Elgin General Hospital, 189 Elm Street, St. Thomas, ON, N5R 5C4, Canada.
| | - Richard O'Reilly
- Department of Psychiatry, Western University, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 0A7, Canada
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,Integrated Department of Mental Health and Addictive Behavior, University Hospital Psychiatry Unit, S. Anna University Hospital and Health Authorities, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
| |
Collapse
|
15
|
Loi F, Marlowe K. East London Modified-Broset as Decision-Making Tool to Predict Seclusion in Psychiatric Intensive Care Units. Front Psychiatry 2017; 8:194. [PMID: 29046647 PMCID: PMC5632740 DOI: 10.3389/fpsyt.2017.00194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/19/2017] [Indexed: 11/16/2022] Open
Abstract
Seclusion is a last resort intervention for management of aggressive behavior in psychiatric settings. There is no current objective and practical decision-making instrument for seclusion use on psychiatric wards. Our aim was to test the predictive and discriminatory characteristics of the East London Modified-Broset (ELMB), to delineate its decision-making profile for seclusion of adult psychiatric patients, and second to benchmark it against the psychometric properties of the Broset Violence Checklist (BVC). ELMB, an 8-item modified version of the 6-item BVC, was retrospectively employed to evaluate the seclusion decision-making process on two Psychiatric Intensive Care Units (patients n = 201; incidents n = 2,187). Data analyses were carried out using multivariate regression and Receiver Operating Characteristic (ROC) curves. Predictors of seclusion were: physical violence toward staff/patients OR = 24.2; non-compliance with PRN (pro re nata) medications OR = 9.8; and damage to hospital property OR = 2.9. ROC analyses indicated that ELMB was significantly more accurate that BVC, with higher sensitivity, specificity, and positive likelihood ratio. Results were similar across gender. The ELMB is a sensitive and specific instrument that can be used to guide the decision-making process when implementing seclusion.
Collapse
Affiliation(s)
- Felice Loi
- Juniper Court Churchill Hospital CAS Behavioural Health, London, United Kingdom
| | - Karl Marlowe
- Millharbour PICU Mile End Hospital East London NHS Foundation Trust, London, United Kingdom
- Centre for Psychiatry Queen Mary University of London, London, United Kingdom
| |
Collapse
|
16
|
Steinauer R, Huber CG, Petitjean S, Wiesbeck GA, Dürsteler KM, Lang UE, Seifert C, Andreeff K, Krausz M, Walter M, Vogel M. Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders. Eur Addict Res 2017; 23:87-96. [PMID: 28351023 DOI: 10.1159/000458757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/01/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Substance use treatment is often performed inside locked wards. We investigate the effects of adopting a policy of open-door treatment for a substance use treatment and dual diagnosis ward. METHODS This is a prospective open-label study investigating 3-month study periods before opening (P1), immediately after (P2), and 1 year after the first period (P3). Data on committed patients, coercion (seclusion, forced medication, absconding events with subsequent police search), violence, and substance use was collected daily. We applied generalised estimating equation models. RESULTS The mean daily number of patients with ongoing commitment changed from 2.64 (P1) to 2.12 (P2) to 0.96 (P3), corresponding to a reduction of relative risk (RR) for having an ongoing commitment by 20% in P2 (RR 0.80; 95% CI 0.66-0.98) and 67% in P3 (RR 0.33; 95% CI 0.25-0.42). The mean daily number of coercive events was 0.29, 0.13, and 0.05, corresponding to a risk for undergoing coercive measures reduced by 56% (RR 0.44; 95% CI 0.22-0.90) and 85% (RR 0.15; 95% CI 0.05-0.45). Substance use, violence or ward atmosphere did not differ significantly. CONCLUSIONS Our results support findings from general psychiatric wards of reduced coercion after adopting a primarily open-door policy. However, coercive events were rare during all periods. The widespread practice of restricting the freedom of inpatients with substance use disorders by locking ward doors is highly questionable.
Collapse
Affiliation(s)
- Regine Steinauer
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|