Narrative Case Notes Have the Potential to Predict Seclusion 3 Days in Advance: A Mixed-Method Analysis

Stepanow, Clara; Stepanow, Jefim; Walter, Marc; Borgwardt, Stefan; Lang, Undine E.; Huber, Christian G.

doi:10.3389/fpsyt.2019.00096

Cited by 6 publications

(7 citation statements)

References 62 publications

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“…Retrospective case note studies are commonly used within medical research [ 29 , 30 ]. Within medical research, retrospective case note research has examined both physical [ 29 , 30 ] and psychiatric conditions [ 31 , 32 ]. In psychiatric care, case note research has been shown to predict seclusion [ 32 ], at-risk groups for PICU referral [ 33 ], and the need for multi-faceted diagnostic tools to ensure accuracy [ 34 ].…”

Section: Strengths and Limitations To The Study Designmentioning

confidence: 99%

“…Inter-rater reliability and how practitioners come to decisions is often limited to assumptions drawn by them. Clinical involvement for accuracy is reliant on clinical records, which allow for the capture of behaviour prior to diagnoses, that may not be captured in typical records, allowing the identification of meaningful predictors for diagnoses [ 32 , 40 ].…”

Section: Strengths and Limitations To The Study Designmentioning

confidence: 99%

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COMplex mental health PAThways (COMPAT) Study: A mixed methods study to inform an evidence-based service delivery model for people with complex needs: Study protocol

Saini

Martin²,

McIntyre

et al. 2022

PLoS ONE

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Background Mental health services for adults, as they are currently configured, have been designed to provide predominantly community-based interventions. It has long been recognised that some patients have such significant clinical and/or risk needs that those needs cannot be adequately met within standard service delivery models, resulting in a pressing need to consider the best models for this group of people. This paper shares a protocol for a mixed methods study that aims to understand: the profile and history of service users described as having complex needs; the decision-making processes by clinicians that lead to complex needs categorisation; service users and carers experience of service use; and, associated economic impact. This protocol describes a comprehensive evaluation that aims to inform an evidence-based service delivery model for people with complex needs. Methods We will use a mixed methods design, combining quantitative and qualitative methods using in-depth descriptive and inferential analysis of patient records, written medical notes and in-depth interviews with service users, carers, and clinicians. The study will include five components: (1) a quantitative description and analysis of the demographic clinical characteristics of the patient group; (2) an economic evaluation of alternative patient pathways; (3) semi-structured interviews about service user and carer experiences; (4) using data from components 1–3 to co-produce vignettes jointly with relevant stakeholders involved in the care of service users with complex mental health needs; and, (5) semi-structured interviews about clinical decision-making by clinicians in relation to this patient group, using the vignettes as example case studies. Discussion The study’s key outcomes will be to: examine the resource use and cost-impact associated with alternative care pathways to the NHS and other sectors of the economy (including social care); explore patient health and non-health outcomes associated with alternative care pathways; and, gain an understanding of a complex service user group and how treatment decisions are made to inform consistent and person-centred future service delivery.

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Section: Strengths and Limitations To The Study Designmentioning

confidence: 99%

Section: Strengths and Limitations To The Study Designmentioning

confidence: 99%

COMplex mental health PAThways (COMPAT) Study: A mixed methods study to inform an evidence-based service delivery model for people with complex needs: Study protocol

Saini

Martin²,

McIntyre

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Retrospective case note studies are commonly used within medical research (29,30). Within medical research, retrospective case note research has examined both physical (29,30) and psychiatric conditions (31,32). In psychiatric care, case note research has been shown to predict seclusion (32), at-risk groups for PICU referral (33), and the need for multi-faceted diagnostic tools to ensure accuracy (34).…”

Section: Strengths and Limitations To The Study Designmentioning

confidence: 99%

COMplex mental health PAThways (COMPAT) Study: a mixed methods study to inform an evidence-based service delivery model for people with complex needs: Study protocol

Saini

Martin²,

McIntyre

et al. 2021

Preprint

View full text Add to dashboard Cite

Background Mental health services for adults, as they are currently configured, have been designed to provide predominantly community-based interventions. It has long been recognised that some patients have such significant clinical and/or risk needs that those needs cannot be adequately met within standard service delivery models, resulting in a pressing need to consider the best models for this group of people. This paper shares a protocol for a mixed methods study that aims to understand: the profile and history of service users described as having complex needs; the decision-making processes by clinicians that lead to complex needs categorisation; service users and carers experience of service use; and, associated economic impact. This protocol describes a comprehensive evaluation that aims to inform an evidence-based service delivery model for people with complex needs. Methods We will use a mixed methods design, combining quantitative and qualitative methods using in-depth descriptive and inferential analysis of patient records, written medical notes and in-depth interviews with service users, carers, and clinicians. The study will include five components: (1) a quantitative description and analysis of the demographic clinical characteristics of the patient group; (2) an economic evaluation of alternative patient pathways; (3) semi-structured interviews about service user and carer experiences; (4) using data from components 1-3 to co-produce vignettes jointly with relevant stakeholders involved in the care of service users with complex mental health needs; and, (5) semi-structured interviews about clinical decision-making by clinicians in relation to this patient group, using the vignettes as example case studies. Discussion The studys key outcomes will be to: examine the resource use and cost-impact associated with alternative care pathways to the NHS and other sectors of the economy (including social care); explore patient health and non-health outcomes associated with alternative care pathways; and, gain an understanding of a complex service user group and how treatment decisions are made to inform consistent and person-centred future service delivery.

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“…Furthermore, it seems that imposing restrictions on patients (i.e. treatment on a closed ward) may increase violent behavior (16,17). However, further research is needed (3,18).…”

Section: The Pros and Cons Of Closed Doors In Psychiatrymentioning

confidence: 99%

Opening the Doors of a Substance Use Disorder Ward—Benefits and Challenges From a Consumer Perspective

et al. 2020

Self Cite

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Open doors in psychiatry have been a subject of controversy in recent years. While some studies postulate the clinical necessity of closed doors, others challenge the theoretical advantages of this setting, mention numerous drawbacks of closed wards, and focus on the advantages of open-door settings. With regard to patients diagnosed with substance use disorders (SUD), other standards may apply. Very little research has been done on this topic. Some studies adopted a consumer perspective (i.e. asking involved parties about their experience of the door status). To the authors' knowledge, no study has so far addressed the ideal setting for the treatment of SUD. With our data from the opening of a specialized SUD ward, we take one step to closing this knowledge gap. Applying a qualitative design, we asked patients and health care professionals (HCP) to report changes following the opening of the ward. The results are mainly in line with the literature on the general psychiatric population. The newly introduced open-door setting was mostly perceived as positive, but some disadvantages were mentioned (e.g. less protection of patients, less control over who enters/leaves the ward, the theoretically increased risk of patients absconding). Moreover, HCP (but not patients) mentioned potentially increased substance use on the ward as an additional disadvantage that could arise. Opening a previously closed ward was generally perceived as a positive and progressive decision. These findings support the trend towards an overall open-door policy in psychiatry.

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Narrative Case Notes Have the Potential to Predict Seclusion 3 Days in Advance: A Mixed-Method Analysis

Cited by 6 publications

References 62 publications

COMplex mental health PAThways (COMPAT) Study: A mixed methods study to inform an evidence-based service delivery model for people with complex needs: Study protocol

COMplex mental health PAThways (COMPAT) Study: A mixed methods study to inform an evidence-based service delivery model for people with complex needs: Study protocol

COMplex mental health PAThways (COMPAT) Study: a mixed methods study to inform an evidence-based service delivery model for people with complex needs: Study protocol

Opening the Doors of a Substance Use Disorder Ward—Benefits and Challenges From a Consumer Perspective

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