Ward Crowding and Incidents of Violence on an Acute Psychiatric Inpatient Unit

Ng, Bradley; Kumar, Shailesh; Ranclaud, Marita; Robinson, Elizabeth

doi:10.1176/appi.ps.52.4.521

Cited by 83 publications

(62 citation statements)

References 52 publications

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“…In the literature on aggression in psychiatric units for adults, clear evidence exists for a greater number of incidents during daylight hours, starting at breakfast and increasing during the day, with a higher frequency in the afternoon and trailing of only at bedtime [37][38][39][40][41]. In line with these results, on this unit, no incidents occurred between 10 p.m. and 7 a.m..…”

Section: Aggression As a Contextual Eventsupporting

confidence: 69%

Registration of aggressive incidents in an adolescent forensic psychiatric unit and implications for further practice

Tremmery

Danckaerts

Bruckers

et al. 2014

Eur Child Adolesc Psychiatry

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Although aggression is part of daily life in psychiatric units for adolescents, empirical data on its prevalence are sparse. Only few studies have described prevalence of aggressive incidents in adolescent psychiatric wards, and data in forensic psychiatric care are even more limited. Available studies reported high prevalence rates of aggression, ranging from 0.4 to 2.4 incidents of aggression per day across (forensic) child and adolescent psychiatric units. Between 27 and 78 % of all admitted youth committed an aggressive act. In this study, we collected systematically registered data of all aggressive incidents from the first 2 years (2010-2012) on a newly established forensic adolescent psychiatric unit, which used a formal aggression management program embedded in the social competence model, which is based on early intervention in the 'chain of behavior' to prevent any further escalation. The inclusion of also minor aggressive incidents is unique in the literature and the clinical relevance is highlighted. A mean of one incident a day took place, with each adolescent involved in at least one incident. Notably, 1.7 aggressive incidents per month made seclusion of restraint use necessary. Based on the social competence theory, the aggression management model suggests intervening early in the cascade of aggression, in order to prevent further escalation and reduce the need for intrusive interventions. Evidence supported that aggression is a contextual event, as external factors clearly influence the incidence of aggression. Aggression management should be built on both relational and structural security.

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Section: Aggression As a Contextual Eventsupporting

confidence: 69%

Registration of aggressive incidents in an adolescent forensic psychiatric unit and implications for further practice

Tremmery

Danckaerts

Bruckers

et al. 2014

Eur Child Adolesc Psychiatry

View full text Add to dashboard Cite

show abstract

“…This may be particularly true for patients with dual diagnosis [29]. Moreover, the opening of a ward may reduce the pressure resulting from overcrowding, which is associated with the frequency of violent incidents [30,31]. Ward occupancy was highest during period 3, further supporting such a mechanism.…”

Section: Discussionmentioning

confidence: 99%

Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

et al. 2017

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Objective: Substance use treatment is often performed inside locked wards. We investigate the effects of adopting a policy of open-door treatment for a substance use treatment and dual diagnosis ward. Methods: This is a prospective open-label study investigating 3-month study periods before opening (P1), immediately after (P2), and 1 year after the first period (P3). Data on committed patients, coercion (seclusion, forced medication, absconding events with subsequent police search), violence, and substance use was collected daily. We applied generalised estimating equation models. Results: The mean daily number of patients with ongoing commitment changed from 2.64 (P1) to 2.12 (P2) to 0.96 (P3), corresponding to a reduction of relative risk (RR) for having an ongoing commitment by 20% in P2 (RR 0.80; 95% CI 0.66-0.98) and 67% in P3 (RR 0.33; 95% CI 0.25-0.42). The mean daily number of coercive events was 0.29, 0.13, and 0.05, corresponding to a risk for undergoing coercive measures reduced by 56% (RR 0.44; 95% CI 0.22-0.90) and 85% (RR 0.15; 95% CI 0.05-0.45). Substance use, violence or ward atmosphere did not differ significantly. Conclusions: Our results support findings from general psychiatric wards of reduced coercion after adopting a primarily open-door policy. However, coercive events were rare during all periods. The widespread practice of restricting the freedom of inpatients with substance use disorders by locking ward doors is highly questionable.

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“…Eighteen months was considered to be of sufficient time to capture a normal clinical complement of patients based on our clinical experience. Given that patient census and crowding have been shown to affect the rates of seclusion and restraint in several studies (Nijman and Rector 1999;Ng et al 2001) we conducted an analysis of our census data. During the 18 month study period prior to the installation of the padded room (August 2001 through January 2003), the average daily female census per month was 8.0 ± 2.3 patients.…”

Section: Methods and Data Analytic Proceduresmentioning

confidence: 99%

“…Thus the unit for seclusion minutes rate is minutes of seclusion per patient served thereby controlling for the possible effects of crowding on violent behavior (Nijman and Rector 1999;Ng et al 2001). The rate of seclusion minutes before and after the padded room installation was then compared using the Mann-Whitney Rank Sum Test (MWRST).…”

Section: Methods and Data Analytic Proceduresmentioning

confidence: 99%

Managing Treatment Resistant Violent Adolescents: A Step Forward by Substituting Seclusion for Mechanical Restraint?

Larson

Sheitman

Kraus

et al. 2007

Adm Policy Ment Health

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Despite a growing consensus that seclusion or restraint should never be used with children or adolescents, there are a few patients who are resistant to treatment, and are persistently violent. The purpose of this study was to measure the efficacy of installing a padded seclusion room to decrease the use of mechanical restraints, a potentially more emotionally traumatic and dangerous intervention than seclusion. After padded room installation, the number of monthly mechanical restraint events per 1000 patient days decreased by 93.7%, from 21.2 to 1.3. A padded seclusion room may offer a safer, albeit a less than desirable alternative to mechanical restraint.

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Ward Crowding and Incidents of Violence on an Acute Psychiatric Inpatient Unit

Abstract: Crowding was found to be significantly associated with aggressive incidents, and in particular with verbal aggression.

Cited by 83 publications

References 52 publications

Registration of aggressive incidents in an adolescent forensic psychiatric unit and implications for further practice

Registration of aggressive incidents in an adolescent forensic psychiatric unit and implications for further practice

Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

Managing Treatment Resistant Violent Adolescents: A Step Forward by Substituting Seclusion for Mechanical Restraint?

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