Patient Violence Toward Psychiatric Health Care Workers in Israel as Viewed Through Incident Reports

A 10-year comparison of short versus long-term court-ordered psychiatric hospitalization: a follow-up study

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.

Extension to 'combined SNA and LDA methods to understand adverse medical events': Doctor and nurse perspectives

BACKGROUND

Physicians and nurses are responsible for reporting medical adverse events. Each views these events through a different lens subject to their role-based perceptions and barriers. Physicians typically engage with diagnosis and treatment while nurses primarily care for patients' daily lives and mental well-being. This results in reporting and describing medical adverse events differently.

OBJECTIVE

We aimed to compare adverse medical event reports generated by physicians and nurses to better understand the differences and similarities in perspective as well as the nature of adverse medical events using social network analysis (SNA) and latent Dirichlet allocation (LDA).

METHODS

The current study examined data from the Maccabi Healthcare Community. Approximately 17,868 records were collected from 2000 to 2017 regarding medical adverse events. Data analysis used SNA and LDA to perform descriptive text analytics and understand underlying phenomenon.

RESULTS

A significant difference in harm levels reported by physicians and nurses was discovered. Shared topic keyword lists broken down by physicians and nurses were derived. Overall, communication, lack of attention, and information transfer issues were reported in medical adverse events data. Specialized keywords, more likely to be used by a physician were determined as: repeated prescriptions, diabetes complications, and x-ray examinations. For nurses, the most common special adverse event behavior keywords were vaccine problem, certificates of fitness, death and incapacity, and abnormal dosage.

CONCLUSIONS

Communication and inattentiveness appeared most frequently in medical adverse events reports regardless of whether doctors or nurses did the reporting. Findings suggest feedback and information sharing processes could be implemented as a step toward alleviating many issues. Institutional management, healthcare managers and government officials should take actions to decrease medical adverse events, many of which may be preventable.

Combined SNA and LDA methods to understand adverse medical events

OBJECTIVE

To compare primary medical adverse event keywords from reporters (e.g. physicians and nurses) and harm level perspectives to explore the underlying behaviors of medical adverse events using social network analysis (SNA) and latent Dirichlet allocation (LDA) leading to process improvements.

DESIGN

Used SNA methods to explore primary keywords used to describe the medical adverse events reported by physicians and nurses. Used LDA methods to investigate topics used for various harm levels. Combined the SNA and LDA methods to discover common shared topic keywords to better understand underlying behaviors of physicians and nurses in different harm level medical adverse events.

SETTING

Maccabi Healthcare Community is the second largest healthcare organization in Israel.

DATA

17,868 medical adverse event data records collected between 2000 and 2017.

METHODS

Big data analysis techniques using social network analysis (SNA) and latent Dirichlet allocation (LDA).

RESULTS

Shared topic keywords used by both physicians and nurses were determined. The study revealed that communication, information transfer, and inattentiveness were the most common problems reported in the medical adverse events data.

CONCLUSIONS

Communication and inattentiveness were the most common problems reported in medical adverse events regardless of healthcare professional reporting or harm levels. Findings suggested that an information-sharing and feedback mechanism should be implemented to eliminate preventable medical adverse events. Healthcare institutions managers and government officials should take targeted actions to decrease these preventable medical adverse events through quality improvement efforts.

Modifiable factors affecting inpatient violence in an acute child and adolescent psychiatric unit: A 16-year retrospective study

Violent incidents in acute inpatient units for children and adolescents are a major and persistent problem. The demographic, clinical, and modifiable (environmental-organizational) risk factors that affect inpatient violence in an Acute Child and Adolescent Psychiatric Unit were investigated via a retrospective study. Data were collected from nursing and medical reports and the unit's census and included 100 days per year for 16 years. Incidents of violence and assault types were recorded, and variables such as the diagnostic category of assailants, total number of patients, and staffing factors during the incident were examined. Of the 2390 violent incidents recorded, 50% were attributed to cases of physical violence towards another patient, 17% to physical violence towards nursing staff, 19% to physical violence towards self and 14% to destruction of property. According to the final multivariable model, for each additional patient in the unit, the risk of a violent event increased by 9.51%; for each additional offender patient, the risk increased by 14.06%; the number of assistant nurses was associated with a 25.03% increased risk; and, after 2006, the risk increased by 68.99%. The most significant factor associated with a 59.98% decreased risk was the total number of nursing staff. All variables significantly and independently contributed to the model. Acute inpatient psychiatric units with a small number of hospitalized patients, adequate, well-trained and specialized nursing staff, and the hospitalization of different types of patients in separate wards or units are expected to facilitate a reduction in the frequency of violent incidents.