P03-14 - A Quasi-Experimental Controlled Intervention to Reduce Violence on an Acute Psychiatric Ward

Abstract

Introduction: Violence and aggression are a major concern in acute inpatient psychiatric wards. Hard outcome data on the impact of service change are scarce. This poster presents the outcomes of service changes designed to improve the acute ward environment and patient experience. Aims and objectives: To implement changes to the delivery of acute inpatient psychiatric services and to measure the outcome of these changes in objective verifiable form. Method: Significant changes were introduced to an acute psychiatric inpatient service. These included introducing a dedicated inpatient psychiatrist "hospitalist", replacing weekly ward rounds with daily multidisciplinary care and discharge planning meetings and promoting increased roles for nursing staff in decision-making and patient contact. Outcomes measured included routinely recorded incidents of violence with and without injury, use of restraint for medication and use of constant nursing observation. The control group was a similar service in the same hospital subject to the same general policies and admitting patients demographically comparable, but that did not at the time undergo the interventions implemented in the trial service. All data was recorded by staff who were unaware of this study or even that any analysis of the data would occur. Results and conclusions: Violent incidents in the intervention ward dropped by 34% per patient (p=< 0.02) whilst increasing by 3% in the control ward; restraints decreased by 28% (p=ns) whilst increasing by 12% in the control ward; with an overall reduction in constant observation. The intervention was highly effective in reducing violent incidents.

Personal continuity versus specialisation of care approaches in mental healthcare: experiences of patients and clinicians—results of the qualitative study in five European countries

“…The literature shows that the specialisation of care approach (SC) is expected to simplify the practical organization of services, support quick clinical decision-making, enable clinical teams and clinicians to focus on only one setting, and foster an expertise in setting specific aspects of treatment [2,4,10]. On the one hand, proponents of this approach claim that the increasing specialisation of psychiatric services represents a progress in our understanding of mental health problems [9].…”

Specialised teams or personal continuity across inpatient and outpatient mental healthcare? Study protocol for a natural experiment

“…This care approach is expected to simplify the practical organisation of services; support quick clinical decision-making; enable clinical teams and clinicians to have a full focus on only one setting; and foster an expertise in setting specific aspects of treatment. 1 6 …”

Continuity Across Inpatient and Outpatient Mental Health Care or Specialisation of Teams? A Systematic Review

“…No randomized controlled trials were identified. There were 13 nonrandomized comparative studies which compared outcomes of continuity and specialisation systems [2,1,14,16,[19][20][21][22]26,27,30,29,31,[36][37][38]40], three survey studies which investigated patient and staff views towards continuity and specialisation systems [3,15,35], and one qualitative semi-structured interview study on staff views towards the two systems [17]. NRT: non-randomized controlled trials; CBA: controlled before and after studies; C: continuity system; S: specialisation system.…”

“…This ranged from comparing systems in which all staff members either worked across inpatient and outpatient settings or within one particular setting; to consultant-based systems (mainly in the UK) which focused only on continuity versus specialisation of consultant psychiatrists. The majority of studies collected data on psychiatric patients [2,1,14,16,19,20,22,26,27,30,29,31,[36][37][38]40,3], although three focused on staff [21,15,17], and one study included both patients and staff [35].…”

“…Overall, nine of the studies were at high risk of selection bias [2,1,14,[20][21][22]27,30,29,31,36] due to uncontrolled confounders or, for before and after studies, due to having no control group for comparison. All studies were also unclear [20,30,29,31,40] or at high risk [2,1,14,16,19,21,22,26,27,[36][37][38] of performance bias due to an imbalance in treatment intensity or the existence of additional co-occurring interventions -such as one treatment group receiving extended 24-hour-care, assertive engagement, or home treatment whilst the other does not. Design specific issues, such as having only one site per intervention group in cluster-level studies or a lack of an appropriate concurrent control altogether, means all the studies were also at high risk of other potential sources of bias.…”