Cost‐effectiveness of staffing levels on conflict and containment on psychiatric wards in England

Abstract

Accessible Summary What is known on the subject? Literature on staffing levels and outcomes in psychiatric wards is limited and shows mixed associations Lack of economic evidence on conflicts and containment in psychiatric care Data from the City‐128 study showed that regular qualified nurse staffing levels in the preceding shifts were associated with raised conflict and containment levels What this paper adds to existing knowledge? This is the first economic analysis using the City‐128 data, with costs and outcomes data have been combined. Cost‐effectiveness of different staffing levels in relation to conflicts and containments in England, using data from the City‐128 study Both day and night shifts appeared to show that the low staff scenario was cost‐effective in terms of conflicts and containment averted, even after attempts were made to adjust for patient severity What are the implications for practice? This paper could be an indication towards further investigation into how mental health inpatient care, specially nursing is organized in England. AbstractIntroductionEvidence from City‐128 study shows a positive association between staffing levels and conflicts/containment. Economic evidence on this topic is scarce, with no economic analyses combining costs and outcomes.Aim/QuestionTo assess the cost‐effectiveness of different staffing levels in relation to conflicts and containments in England, using City‐128 study data.MethodsShifts were grouped into three groups based on staff‐to‐bed ratio. Cost information was combined with total conflicts and containment measures to assess cost‐effectiveness.ResultsThe cost‐effectiveness analysis of the three staffing scenarios for both day and night shifts appeared to show that the low staff scenario was cost‐effective in terms of conflicts and containment averted, even adjusting for patient severity. A production function analysis also revealed that increased staff numbers were associated with higher numbers of events.DiscussionCausation cannot be attributed and neither can recommendations be made on optimal staffing levels. The impact on other outcomes such as symptoms, functioning and length of stay, and other factors should be explored, and these may all benefit from increased staff numbers.Implications for practiceThese results indicate that increasing staff numbers may not necessarily improve conflict and containment outcomes. They may produce positive outcomes in other domains.

Space and Well-Being in High Security Environments

“…For the verbal aggression and property damage incidents similar results were found as for physical aggression. These findings are not in line with the literature reporting an association of high bed occupation with aggression and coercive measures, but add to research pointing at a link between staffing and incidents ( 56 ). The authors acknowledge that there may be “complex organizational and relational factors that need further research to fully understand the overall context” (p. 1).…”

Developing nurse‐sensitive outcomes in acute inpatient mental health settings—A systematic review

“…Of the 56 studies located in the search process, 16 were related to three datasets from programs of research by Bowers and colleagues investigating conflict and containment rates and various nursing and other variables in acute psychiatric inpatient wards (Baker et al, 2009; Bowers, 2009; Bowers, Allan, et al, 2007; Bowers, Allan, Simpson, Jones, Van Der Merwe, & Jeffery, 2009; Bowers, Allan, Simpson, Jones, & Whittington, 2009; Bowers & Crowder, 2012; Bowers et al, 2006, 2012, 2013; Bowers, Flood, et al, 2008; Bowers, Jeffery, et al, 2007; Bowers, Whittington, et al, 2008; Bowers et al, 2010; E‐Morris et al, 2010; Kartha & McCrone, 2019; Papadopoulos et al, 2012; Stewart & Bowers, 2012). Conflict and containment are patient behaviours and staff actions that form a significant part of the nurse–patient relationship in acute psychiatric inpatient wards (Bowers, 2006).…”

“…Kartha and McCrone (2019) also used the dataset to conduct an economic evaluation using three different staffing levels. The cost‐effectiveness analysis of the three staffing scenarios showed that the low staff scenario was cost‐effective in terms of conflicts and containment averted.…”

The use and impact of surveillance-based technology initiatives in inpatient and acute mental health settings: A systematic review

“…Use of these technologies is justified on the basis that they may be able to detect or prevent aggressive and violent incidents, reduce self-harm incidents and suicide attempts, improve staff and patient safety, change patient behaviour and staff conduct, provide accurate records to help resolve complaints and to contribute to legal cases, and reduce staffing costs [13,14,15,16,17]. Reducing cost is a driving force for many service providers, and both conflict on wards and providing adequate staffing are costly [18] but interrelated [19,20]; surveillance technologies may therefore appear to offer a cost-effective solution.…”