Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission

Hdl Handle:
http://hdl.handle.net/10147/582801
Title:
Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission
Authors:
Davoren, Mary; Byrne, Orla; O’Connell, Paul; O’Neill, Helen; O’Reilly, Ken; Kennedy, Harry G
Citation:
BMC Psychiatry. 2015 Nov 23;15(1):301
Issue Date:
23-Nov-2015
URI:
http://dx.doi.org/10.1186/s12888-015-0686-4; http://hdl.handle.net/10147/582801
Abstract:
Abstract Background Patients admitted to a secure forensic hospital are at risk of a long hospital stay. Forensic hospital beds are a scarce and expensive resource and ability to identify the factors predicting length of stay at time of admission would be beneficial. The DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale are designed to assess need for therapeutic security and urgency of that need while the HCR-20 predicts risk of violence. We hypothesized that items on the DUNDRUM-1 and DUNDRUM-2 scales, rated at the time of pre-admission assessment, would predict length of stay in a medium secure forensic hospital setting. Methods This is a prospective study. All admissions to a medium secure forensic hospital setting were collated over a 54 month period (n = 279) and followed up for a total of 66 months. Each patient was rated using the DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale as part of a pre-admission assessment (n = 279) and HCR-20 within 2 weeks of admission (n = 187). Episodes of harm to self, harm to others and episodes of seclusion whilst an in-patient were collated. Date of discharge was noted for each individual. Results Diagnosis at the time of pre-admission assessment (adjustment disorder v other diagnosis), predicted legal status (sentenced v mental health order) and items on the DUNDRUM-1 triage security scale and the DUNDRUM-2 triage urgency scale, also rated at the time of pre-admission assessment, predicted length of stay in the forensic hospital setting. Need for seclusion following admission also predicted length of stay. Conclusions These findings may form the basis for a structured professional judgment instrument, rated prior to or at time of admission, to assist in estimating length of stay for forensic patients. Such a tool would be useful to clinicians, service planners and commissioners given the high cost of secure psychiatric care.
Language:
en
Keywords:
FORENSIC MENTAL HEALTH; ACUTE CARE; HOSPITAL ADMISSIONS; ASSESSMENT SCALES

Full metadata record

DC FieldValue Language
dc.contributor.authorDavoren, Maryen
dc.contributor.authorByrne, Orlaen
dc.contributor.authorO’Connell, Paulen
dc.contributor.authorO’Neill, Helenen
dc.contributor.authorO’Reilly, Kenen
dc.contributor.authorKennedy, Harry Gen
dc.date.accessioned2015-11-27T12:31:00Zen
dc.date.available2015-11-27T12:31:00Zen
dc.date.issued2015-11-23en
dc.identifier.citationBMC Psychiatry. 2015 Nov 23;15(1):301en
dc.identifier.urihttp://dx.doi.org/10.1186/s12888-015-0686-4en
dc.identifier.urihttp://hdl.handle.net/10147/582801en
dc.description.abstractAbstract Background Patients admitted to a secure forensic hospital are at risk of a long hospital stay. Forensic hospital beds are a scarce and expensive resource and ability to identify the factors predicting length of stay at time of admission would be beneficial. The DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale are designed to assess need for therapeutic security and urgency of that need while the HCR-20 predicts risk of violence. We hypothesized that items on the DUNDRUM-1 and DUNDRUM-2 scales, rated at the time of pre-admission assessment, would predict length of stay in a medium secure forensic hospital setting. Methods This is a prospective study. All admissions to a medium secure forensic hospital setting were collated over a 54 month period (n = 279) and followed up for a total of 66 months. Each patient was rated using the DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale as part of a pre-admission assessment (n = 279) and HCR-20 within 2 weeks of admission (n = 187). Episodes of harm to self, harm to others and episodes of seclusion whilst an in-patient were collated. Date of discharge was noted for each individual. Results Diagnosis at the time of pre-admission assessment (adjustment disorder v other diagnosis), predicted legal status (sentenced v mental health order) and items on the DUNDRUM-1 triage security scale and the DUNDRUM-2 triage urgency scale, also rated at the time of pre-admission assessment, predicted length of stay in the forensic hospital setting. Need for seclusion following admission also predicted length of stay. Conclusions These findings may form the basis for a structured professional judgment instrument, rated prior to or at time of admission, to assist in estimating length of stay for forensic patients. Such a tool would be useful to clinicians, service planners and commissioners given the high cost of secure psychiatric care.en
dc.language.isoenen
dc.subjectFORENSIC MENTAL HEALTHen
dc.subjectACUTE CAREen
dc.subjectHOSPITAL ADMISSIONSen
dc.subjectASSESSMENT SCALESen
dc.titleFactors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admissionen
dc.language.rfc3066enen
dc.rights.holderDavoren et al.en
dc.date.updated2015-11-23T17:02:30Zen
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