In-patient costs of agitation and containment in a mental health catchment area

Serrano‐Blanco, Antoni; Rubio-Valera, María; Aznar-Lou, Ignacio; Baladón, Luisa; Gibert, Karina; Canales, Alfredo Gracia; Kaskens, Lisette; Ortiz, José M.; Salvador‐Carulla, Luis

doi:10.1186/s12888-017-1373-4

Cited by 28 publications

(22 citation statements)

References 32 publications

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“…While it is considered to be distinctly different to aggression [2], without timely assessment and management it can quickly escalate to a loss of personal control, aggression and violence [1] and result in injury to patients and staff [3,4]. Agitation can also lead to increased periods of hospitalisation [5] and episodes of readmission [6] resulting in increased health care costs [5,7].…”

Section: Introductionmentioning

confidence: 99%

Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions

Tucker¹,

Whitehead

Palamara

et al. 2020

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Background: Agitation among patients is a common and distressing behaviour across a variety of health care settings, particularly inpatient mental health. Unless recognised early and effectively managed it can lead to aggression and personal injury. The aim of this paper is to explore the experiences of mental health nurses in recognising and managing agitation in an inpatient mental health setting and the alignment of these experiences with best practice and person-centred care. Methods: This study used a qualitative cross-sectional descriptive methodology. Semi-structured focus group interviews were conducted with twenty-one nurses working in a mental health unit in 2018. Nursing staff described their experiences of assessing and managing agitation. Descriptive and Thematic Analysis were undertaken of the transcribed focus group dialogue. Results: Nurses combined their clinical knowledge, assessment protocols and training with information from patients to make an individualised assessment of agitation. Nurses also adopted an individualised approach to management by engaging patients in decisions about their care. In keeping with best practice recommendations, de-escalation strategies were the first choice option for management, though nurses also described using both coercive restraint and medication under certain circumstances. From the perspective of patient-centred care, the care provided aligned with elements of person-centred care nursing care.Conclusion: The findings suggest that clinical mental health nurses assess and manage agitation, with certain exceptions, in line with best practice and a person-centred care nursing framework.

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Section: Introductionmentioning

confidence: 99%

Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions

Tucker¹,

Whitehead

Palamara

et al. 2020

Preprint

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“…As far as we know, only two studies contain information on the costs of agitation and aggression in psychiatric inpatients. Annual economic costs of aggression incidents were estimated to be €280535 and £179 million (€211 million (7)) in Spain and the United Kingdom, respectively (8,9). Both estimates are considered underestimates of the actual costs because indirect costs were not taken into account.…”

Section: Introductionmentioning

confidence: 99%

Economic impact of aggression in closed long-stay psychiatric wards

Bles

Hazewinkel

Bogers

et al. 2020

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Background : Aggressive behaviour (i.e. verbal, physical towards objects, self, or others) is highly prevalent in long-term psychiatric inpatient care. We aimed to estimate the overall incidence of aggression, the time staff took to handle aggression incidents, and the weighted average financial costs thereof. Methods : A random sampling procedure was conducted at three long-term psychiatric inpatient care facilities, covering all weekdays and work shifts (day, evening, and night). Psychiatric nurses were asked to recall all incidents of their shift. For the time spent on each type of incident, members of staff were monitored in real-time for a period of one week. Estimated costs were calculated by the time spent multiplied by hourly wages in addition to any material-related costs. Results : The incidence rates were 90 incidents per patient year: 63 for verbal aggression, 8 for physical aggression towards objects, 7 for self-harm, and 12 for physical aggression towards others. The average time spent per incident was 125 minutes but differed for each type of incident. Almost 80% of this time was consumed by nursing staff. The average cost per aggression incident was €78; extrapolated per patient year, the total costs were approximately €7000. Conclusions : The current study found a high rate of aggression incidents in closed long-stay psychiatric wards, particularly when accounting for verbal aggression. Reports of aggression on these types of wards are scarce. Nevertheless, aggression seems to have a severe impact on invested time and related costs, which suggests a need for aggression-prevention and de-escalating programs.

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“…Recent literature recommends verbal de-escalation and changes to patient environment as preferred first line treatment options followed by pharmacological intervention, with restraint as a last resort [ 4 ]. The impact of agitation on the healthcare system has been previously described; a 2013 analysis of Spanish Acute Impatient admissions identified that agitation increased the cost of an admission between €282 and €822, dependant on the interventions required to manage the episode [ 5 ]. However, the impact of agitation on costs to the healthcare system for community dwelling patients is not well known.…”

Section: Introductionmentioning

confidence: 99%

A survey of caregiver burden in those providing informal care for patients with schizophrenia or bipolar disorder with agitation: results from a European study

et al. 2018

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BackgroundAgitation is a common feature of bipolar disorder and schizophrenia. Previous research indicates that specific symptoms impact caregiver burden in these conditions, but the impact of agitation on caregiver experience is poorly understood. The aim of this study was to characterise caregiver burden in providers of informal care for patients with bipolar disorder and schizophrenia who experience agitation.MethodsIn total, 297 matched patient and caregiver surveys were collected across the UK, Germany and Spain between October 2016 and January 2017. To be eligible, caregivers needed to provide informal care to a patient with a diagnosis of bipolar disorder or schizophrenia with agitation managed in a community setting and participating in the patient survey. The caregiver survey captured information on demographics and their role in managing the patient’s agitation. Caregiver burden was assessed using the Involvement Evaluation Questionnaire. Descriptive analysis was conducted.ResultsCaregivers provided 38.3 h (SD ± 40.34) a week of support to the patient with 20% providing 50 h or more. Most caregivers reported that they recognised an episode of agitation all of the time (44%, n = 130) or sometimes (40%, n = 119). Verbal de-escalation techniques (talking (80%, n = 239) and soothing (73%, n = 218) were the most commonly reported strategies used by caregivers during an episode of agitation; 14% (n = 43) reported resorting to physically restraining the patient. Caregivers supervised rescue medication administration regularly (41%, n = 69) or occasionally (49%, n = 82). Mean Involvement Evaluation Questionnaire score was 32.2 (± 15.27), equivalent to 28.4 (± 13.56) in Germany, 35.6 (± 16.55) in Spain and 33.3 (± 15.15) in the UK. Involvement Evaluation Questionnaire scores were higher for caregivers who reported hostile (41.7 ± 17.07) lack of control (40.3 ± 16.35) and violent (39.5 ± 16.40) patient behaviours when agitated. Over excitement (31.8 ± 15.05), restless (32.6 ± 14.77) and tense (32.9 ± 15.64) behaviours were associated with a lower Involvement Evaluation Questionnaire score.ConclusionsCaregivers are active participants in the recognition and management of agitation episodes. The substantial burden reported by these caregivers is impacted by factors including the number of hours of care provided, patient behaviours and country. These may be viable targets for effective interventions to reduce caregiver burden.

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In-patient costs of agitation and containment in a mental health catchment area

Cited by 28 publications

References 32 publications

Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions

Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions

Economic impact of aggression in closed long-stay psychiatric wards

A survey of caregiver burden in those providing informal care for patients with schizophrenia or bipolar disorder with agitation: results from a European study

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