DUNDRUM-2: Prospective validation of a structured professional judgment instrument assessing priority for admission from the waiting list for a forensic mental health hospital

Abstract

BackgroundThe criteria for deciding who should be admitted first from a waiting list to a forensic secure hospital are not necessarily the same as those for assessing need. Criteria were drafted qualitatively and tested in a prospective 'real life' observational study over a 6-month period.MethodsA researcher rated all those presented at the weekly referrals meeting using the DUNDRUM-1 triage security scale and the DUNDRUM-2 triage urgency scale. The key outcome measure was whether or not the individual was admitted.ResultsInter-rater reliability and internal consistency for the DUNDRUM-2 were acceptable. The DUNDRUM-1 triage security score and the DUNDRUM-2 triage urgency score correlated r = 0.663. At the time of admission, after a mean of 23.9 (SD35.9) days on the waiting list, those admitted had higher scores on the DUNDRUM-2 triage urgency scale than those not admitted, with no significant difference between locations (remand or sentenced prisoners, less secure hospitals) at the time of admission. Those admitted also had higher DUNDRUM-1 triage security scores. At baseline the receiver operating characteristic area under the curve for a combined score was the best predictor of admission while at the time of admission the DUNDRUM-2 triage urgency score had the largest AUC (0.912, 95% CI 0.838 to 0.986).ConclusionsThe triage urgency items and scale add predictive power to the decision to admit. This is particularly true in maintaining equitability between those referred from different locations.

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

“…These elements inherent in the role of the forensic psychiatrist are even more pronounced in leadership positions. By deciding on issues such as referral, discharge, recall and triage criteria [25,26] and appropriate levels of security [27], directors of forensic units are, in effect, participating in defining which behavioral issues that society faces should be treated within general psychiatric services, forensic services or the penal system, i.e. how society's forensic population is to be demarcated.…”

Prospective study of factors influencing conditional discharge from a forensic hospital: the DUNDRUM-3 programme completion and DUNDRUM-4 recovery structured professional judgement instruments and risk

“…The first two instruments of the DUNDRUM Toolkit are concerned with the admission of patients to secure hospitals, acting as structured professional judgement instruments to decide the level of need for therapeutic security and the urgency of that need [10]. We have previously shown that these two instruments distinguished between patients who required admission to different levels of therapeutic security and distinguished the urgency of need amongst patients [11,12]. The DUNDRUM-3 and DUNDRUM-4 scales are structured professional judgement instruments to rate a patient’s programme completion and recovery and therefore the patient’s continuing need for therapeutic security [10].…”

Prospective in-patient cohort study of moves between levels of therapeutic security: the DUNDRUM-1 triage security, DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales and the HCR-20

“…The DUNDRUM toolkit is a suite of structured professional judgement instruments developed at the Central Mental Hospital Dundrum, Dublin, Ireland [1]. The toolkit is a set of instruments designed to assist clinical decision making when assessing the need for therapeutic security (DUNDRUM-1 triage security) [2] and urgency of need for therapeutic security (DUNDRUM-2 triage urgency) [3], assessing a patient's programme completion (DUNDRUM-3) and recovery (DUNDRUM-4) and therefore their ongoing need for security as well as a self rated instrument in which patients assess their own need for therapeutic security [1]. …”