Characteristics and clinical outcomes for mental health patients admitted to a behavioural assessment unit: Implications for model of care and practice (original) (raw)
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Australian Health Review, 2007
This study was conducted to evaluate a behavioural assessment room (BAR) as a strategy in the management of people exhibiting acute behavioural disturbance in the St Vincent's Hospital, Melbourne Emergency Department (ED). The study involved a retrospective audit of the data documented for BAR use over a 12-month period and a structured questionnaire of clinical and nonclinical emergency department staff.
Behavioural assessment unit improves outcomes for patients with complex psychosocial needs
Emergency medicine Australasia : EMA, 2017
We aimed to assess the impact of a new model of care for patients presenting to the ED with acute behavioural disturbance. This pre-/post-intervention study involved creating a dedicated, highly resourced six bed unit, the behavioural assessment unit (BAU). Co-located with the ED at the Royal Melbourne Hospital, the unit was designed to fast-track the admission of patients affected by intoxication, mental illness or psychosocial crisis and provide front-loaded interventions. In 12 months from 1 April 2016, 2379 patients were admitted to the BAU. They were compared with a similar cohort of 3047 patients from the entire 2015 ED population. The BAU resulted in a decreased wait to be seen (40 min [interquartile range (IQR): 17-86] vs 68 min [IQR: 24-130], P < 0.001), a decreased wait for a mental health review (117 min [IQR: 49-224] vs 139 min [IQR: 57-262], P = 0.001) and a decreased ED length of stay (180 min [IQR: 101-237] vs 328 min [IQR: 227-534], P < 0.001). Patients admitte...
Aggressive behaviors in the psychiatric emergency service
Open Access Emergency Medicine, 2011
Introduction: Studies of aggressive behaviors in a nonforensic mental health setting have focused primarily on the inpatient ward and, on event prediction, using behavior-based clinical rating scales. Few studies have specifically targeted aggressive behaviors in the psychiatric emergency service or determined whether assessing the demographic and clinical characteristics of such patients might prove useful for their more rapid identification. Methods: We used a prospectively acquired database of over 20,900 visits to four services in the province of Quebec, Canada, over a two-year period from September 2002 onwards. A maximum of 72 variables could be acquired per visit. Visits with aggression (any verbally or physically intimidating behavior), both present and past, were tagged. Binary logistic regressions and cross-tabulations were used to determine whether the profile of a variable differed in visits with aggression from those without aggression. Results: About 7% of visits were marked by current aggression (verbal 49%, physical 12%, verbal and physical 39%). Including visits with a "past only" history of aggression increased this number to 20%. Variables associated with aggression were gender (male), marital status (single/separated), education (high school or less), employment (none), judicial history (any type), substance abuse (prior or active), medication compliance (poor), type of arrival to psychiatric emergency services (involuntary, police, judiciary, landlord), reason for referral (behavioral dyscontrol), diagnosis (less frequent in anxiety disorders), and outcome (more frequently placed under observation or admitted). Conclusion: Our results suggest that many state-independent variables are associated with aggressive behaviors in the psychiatric emergency service. Although their sum may not add up to a specific patient profile, they can nevertheless be useful in service planning, being easily integrated alongside state-dependent rating scales in a triage and/or observation instrument for daily use in the psychiatric emergency service.
The western journal of emergency medicine, 2017
Effective strategies for managing acute behavioural disturbances (ABDs) within emergency departments (EDs) are needed given their rising occurrence and negative impact on safety, psychological wellbeing, and staff turnover. Non-pharmacological interventions for ABD management generally fall into four categories: environmental modifications; policies; practice changes; and education. Our objective was to systematically review the efficacy of strategies for ABD management within EDs that involved changes to environment, architecture, policy and practice. We performed systematic searches of CINAHL Plus with Full Text, PsycINFO, MEDLINE, and EMBASE, as well as reference lists of relevant review articles to identify relevant studies published between January 1985 - April 2016. We included studies written in English, which reported management of behavioural disturbances in adults associated with the ED through the use of environmental modifiers (including seclusion, restraint, specialised...
Journal of Mental Health, 2012
Background: Violence and aggression is common in mental health care and physical restraint is used frequently. Control and restraint (general services) (C&R (GS)) and Strategies in Crisis Intervention and Prevention (SCIP) are often used. There had not been any study evaluating the outcomes of the different approaches of restraint method. Aim: To compare the effectiveness of C&R (GS) and SCIP. Method: A retrospective cohort study design was employed to compare the rates of disturbed incidents. The patients admitted to C&R (GS) and SCIP wards were investigated to study the effectiveness of the two approaches of physical restraint. Results: The study suggests that C&R (GS) achieved better outcomes than SCIP. Patients exposed to SCIP had longer hospitalisation, were involved in higher rate of incidents of disturbed behaviour; had lower survival and higher failure probabilities and a higher relative hazard ratio. Conclusions: There is a need to debate the evidence base of the various approaches currently used in physical intervention in the management of disturbed behaviour by mental health services providers. The better outcomes demonstrated by C&R (GS) challenges the current trend in and the value of mental health practice.