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Characteristics of acute wards associated with the presence of a psychiatric intensive care unit, and transfers of patients to it

Published online by Cambridge University Press:  08 June 2012

Len Bowers ,
Natalie Hammond ,
Karen James ,
Alan Quirk ,
Debbie Robson  and
Duncan Stewart
Len Bowers*
Affiliation:
Professor of Psychiatric Nursing Institute of Psychiatry, Kings College London
Natalie Hammond
Affiliation:
Consultant Nurse, Promotion of Safe & Therapeutic Services, South London and Maudsley NHS Foundation Trust
Karen James
Affiliation:
Institute of Psychiatry, Kings College London Research Assistant
Alan Quirk
Affiliation:
Senior Research Fellow, College Centre for Quality Improvement, Royal College of Psychiatrists, UK
Debbie Robson
Affiliation:
Institute of Psychiatry, Kings College London Tutor
Duncan Stewart
Affiliation:
Institute of Psychiatry, Kings College London Research Fellow
*
Correspondence to: Professor Len Bowers, PO Box 30, David Goldberg Building, Institute of Psychiatry, Health Service and Population Research, De Crespigny Park, Denmark Hill, London SE5 8AF. E-mail: len.bowers@kcl.ac.uk
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Abstract

Background: Psychiatric intensive care units (PICU) are a potentially expensive component of inpatient services, and exists to care for those patients who cannot be easily contained on ordinary acute wards. However, to date there is little evidence on their efficacy.

Methods: Using data from a previous study of 136 acute psychiatric wards in England (City-128) we examined whether ordinary acute wards having access to a PICU had lower rates of adverse incidents, and modelled behaviours associated with PICU transfer rates.

Results: Controlling for other factors, wards with greater ease of PICU access did not have lower rates of adverse incidents. PICU provision is related in complex ways to the use of seclusion. PICU transfers were associated with seclusion, manual restraint and other severe containment measures, and were triggered by aggression, drug use and absconding.

Conclusions: Transferring patients to a PICU may not be an effective means of reducing adverse incidents on acute wards and may not have appreciable cost benefits. However, PICUs may still produce a range of valued outcomes such as injury reduction, more effective and efficient treatment, greater feelings of security on acute wards, and care for patients within the criminal justice system. Larger and more detailed evaluations using longitudinal data are required.

Keywords

Aggressionoutcomeevaluation
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 8 , Issue 2 , August 2012 , pp. 66 - 77
Copyright
Copyright © NAPICU 2011

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References

American Psychiatric Association, American Psychiatric Nurses Association and National Association of Psychiatric Health Systems (2003) Learning From Each Other: Success stories and ideas for reducing restraint/seclusion in behavioural health. Washington DC: APA, APNA & NAPHS. www.naphs.org/rscampaign/learning.pdfGoogle Scholar
Anderson, N. and West, M. (1999) Team Climate Inventory (TCI): User's guide. Windsor: NFER-Nelson Publishing.Google Scholar
Bass, B. and Avolio, B. (1995) Multifactor Leadership Questionnaire. Redwood City, CA: Mind Garden.Google Scholar
Birnie, W. A. and Natsuna, K. (1988) The psychiatric acute observation unit in a general hospital. Canadian Journal of Psychiatry. 33: 707–710.CrossRefGoogle ScholarPubMed
Bowers, L. (2009) Association between staff factors and levels of conflict and containment on acute psychiatric wards in England. Psychiatric Services. 60: 231–239.CrossRefGoogle ScholarPubMed
Bowers, L. and Allan, T. (2006) The Attitude to Personality Disorder Questionnaire: psychometric properties and results. Journal of Personality Disorders. 20: 281–293.CrossRefGoogle ScholarPubMed
Bowers, L. and Flood, C. (2008) Nurse staffing, bed numbers and the cost of acute psychiatric inpatient care in England. Journal of Psychiatric and Mental Health Nursing. 15: 630–637.CrossRefGoogle ScholarPubMed
Bowers, L., Alexander, J., Callaghan, P., Eales, S., Guy, S., Mccann, E. and Ryan, C. (2002) Safety and security policies on psychiatric acute admission wards: results from a London-wide survey. Journal of Psychiatric and Mental Health Nursing. 9: 427–433.CrossRefGoogle ScholarPubMed
Bowers, L., Douzenis, A., Galeazzi, G., Forghieri, M., Tsopelas, C., Simpson, A. and Allan, T. (2005) Disruptive and dangerous behaviour by patients on acute psychiatric wards in three European centres. Social Psychiatry and Psychiatric Epidemiology. 40: 822–828.CrossRefGoogle ScholarPubMed
Bowers, L., van der Werf, B., Vokkolainen, A., Muir-Cochrane, E., Allan, T. and Alexander, J. (2007) International variation in containment measures for disturbed psychiatric inpatients. International Journal of Nursing Studies. 44: 357–364.CrossRefGoogle ScholarPubMed
Bowers, L., Jeffery, D., Bilgin, H., Jarrett, M., Simpson, A. and Jones, J. (2008a) Psychiatric intensive care units: a literature review. International Journal of Social Psychiatry. 54: 56–68.CrossRefGoogle ScholarPubMed
Bowers, L., Whittington, R., Nolan, P., Parkin, D., Curtis, S., Bhui, K., Hackney, D., Allan, T. and Simpson, A. (2008b) The relationship between service ecology, special observation and self-harm during acute in-patient care: the City-128 study. British Journal of Psychiatry. 193: 395–401.CrossRefGoogle ScholarPubMed
Bowers, L., van der Merwe, M., Nijman, H., Hamilton, B., Noorthoorn, E., Stewart, D. and Muir-Cochrane, E. (2010) The practice of seclusion and time out on English acute psychiatric wards: the City-128 study. Archives of Psychiatric Nursing. 24: 275–286.CrossRefGoogle ScholarPubMed
Bowers, L., Ross, J., Nijman, H., Muir-Cochrane, E., Noorthoorn, E. and Stewart, D. (2012) The scope for replacing seclusion with time out in acute inpatient psychiatry in England. Journal of Advanced Nursing. 68(4): 826–835.CrossRefGoogle ScholarPubMed
Brown, S. and Bass, N. (2004) The psychiatric intensive care unit: patient characteristics, treatment and outcome. Journal of Mental Health. 13: 601–609.CrossRefGoogle Scholar
Garcia, I., Kennett, C., Quraishi, M. and Durcan, G. (2005) Acute Care 2004. A national survey of adult psychiatric wards in England. London: Sainsbury Centre for Mental Health. 136 pp.Google Scholar
Hyde, C. E. and Harrower-Wilson, C. (1996) Psychiatric intensive care in acute psychosis. International Clinical Psychopharmacology. 11: 61–65.CrossRefGoogle ScholarPubMed
Janssen, W., Noorthoorn, E., de Vries, W., Hutschemaekers, G. and Lendermeijer, B. (2008) The use of seclusion in the Netherlands compared to countries in and outside Europe. International Journal of the Law and Psychiatry. 31: 463–470.CrossRefGoogle ScholarPubMed
Maslach, C. and Jackson, S. (1981) The Maslach Burnout Inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Moos, R. (1997) Evaluating Treatment Environments. New Brunswick: Transaction Publishers.Google Scholar
Muir-Cochrane, E., van der Merwe, M., Nijman, H., Haglund, K., Simpson, A. and Bowers, L. (2012) Investigation into the acceptability of door locking to staff, patients, and visitors on acute psychiatric wards. International Journal of Mental Health Nursing. 21: 41–49.CrossRefGoogle ScholarPubMed
Nijman, H., Bowers, L., Haglund, K., Muir Cochrane, E., Simpson, A. and van der Merwe, M. (2011) Door locking and exit security measures on acute psychiatric admission wards. Journal of Psychiatric and Mental Health Nursing. 18(7): 614–621.CrossRefGoogle ScholarPubMed
Noble, M., Wright, G., Dibben, C., Smith, G., Mclennan, D., Anttila, C., Barnes, H., Mokhtar, C., Noble, S., Avenell, D., Gardner, J. and Lloyd, M. (2004) The English Indices of Deprivation 2004. West Yorkshire: OPDM Publications.Google Scholar
StataCorp (2009) Stata Statistical Software: Release 11. College Station, TX: StataCorp LP.Google Scholar
Stewart, D., van der Merwe, M., Bowers, L., Simpson, A. and Jones, J. (2010) A review of interventions to reduce mechanical restraint and seclusion among adult psychiatric inpatients. Issues in Mental Health Nursing. 31: 413–424.CrossRefGoogle ScholarPubMed
Whittington, R., Bowers, L., Nolan, P., Simpson, A. and Neil, L. (2009) Approval ratings of inpatient coercive interventions in a national sample of mental health service users and staff in England. Psychiatric Services. 60: 792–798.CrossRefGoogle Scholar