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Cited by 87Psychiatric care and mental health servicesHealthcare Decision-Making and RestraintsPsychopathy, Forensic Psychiatry, Sexual Offending

Adverse Incidents in Acute Psychiatric Inpatient Units: Rates, Correlates and Pressures

Carr, Vaughan J., Lewin, Terry J., Sly, Ketrina A., Conrad, Agatha M., Tirupati, Srinivasan, Cohen, Martin, Ward, Philip B., Coombs, Tim·2008·Australian & New Zealand Journal of Psychiatry
DOI 10.1080/00048670701881520
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Abstract

Objective: This paper reports findings from a multicentre service evaluation project conducted in acute psychiatric inpatient units in NSW, Australia. Overall rates of aggression, absconding and early readmission are reported, as well as length-of-stay profiles and associations between these outcomes and selected sociodemographic and clinical characteristics routinely collected by health services. Method: Data from the 11 participating units were collected for a 12month period from multiple sources, including electronic medical records, routine clinical modules, incident forms, and shift based project-specific logs. For the current analyses, two admission-level datasets were used, comprising aggregated patient-level events (n=3242 admissions) and basic sociodemographic, clinical, admission and discharge information (n=5546 admissions by 3877 patients). Results: The participating units were under considerable strain: 23.3% of admissions were high acuity; 60.4% had previous hospital stays; 47.6% were involuntary; 25–30% involved adverse incidents; bed occupancy averaged 88.4%; median length of stay was 8days (mean=14.59days); and 17.4% had a subsequent early readmission. Reportable aggressive incidents (11.2% of admissions) were intermittent (averaging 0.55 incidents per month per occupied bed) and associated with younger age, personality disorder, less serious aggression, longer periods of hospitalization, and subsequent early readmission. Less serious aggressive incidents (15.0% of admissions) were maximal in the first 24h (averaging 3.73 incidents per month per occupied bed) and associated with younger age, involuntary status, bipolar and personality disorders, the absence of depression, and longer hospital stays. Absconding (15.7% of admissions) peaked in the second week following admission and was associated with drug and alcohol disorder, younger age, and longer periods of hospitalization. Conclusions: By examining relationships between a core set of risk factors and multiple short-term outcomes, we were able to identify several important patterns, which were suggestive of the need for a multi-level approach to intervention, shifting from a risk management focus during the early phase of hospitalization to a more targeted, therapeutic approach during the later phase. But the latter approach may not be achievable under current circumstances with existing resources.

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  • The use of seclusion and restraint is linked to detrimental outcomes for patients including increased risk of death, and their use is linked to cultural and institutional factors within organisations including staff attitudes and staffing levels.

    “While it might appear self-evident that seclusion and restraint would be more common in involuntary admissions than voluntary admissions, it is widely recognised that the use of seclusion and restraint is linked to detrimental outcomes for patients including increased risk of death, and their use is linked to cultural and institutional factors within organisations including staff attitudes and st”

    From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [90]

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Authors
Carr, V. J., Lewin, T. J., Sly, K. A., Conrad, A. M., Tirupati, S., Cohen, M., Ward, P. B., & Coombs, T.
Affiliations
  • Hunter New England Local Health District (AU)
  • Liverpool Hospital (AU)
  • New South Wales Institute of Psychiatry (AU)
ORCID
Venue
Australian & New Zealand Journal of Psychiatry
Publisher
SAGE Publications
Published
2008-01-01
Volume
42
Issue
4
Pages
267-282
ISSN
  • 0004-8674 (ISSN-L)
  • 1440-1614
DOI
10.1080/00048670701881520
OpenAlex
W2127129956
Cited by
87
References
51
Citations by year
2025: 1 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 3 · 2019: 9 · 2017: 9 · 2016: 11 · 2015: 10 · 2014: 5 · 2013: 7 · 2012: 4
FWCI
5.56
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Australian & New Zealand Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • NOVA (University of Newcastle Australia) (submittedVersion)
Funders
Department of Health and Aged Care, Australian Government
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
adverse events, acute psychiatric inpatient unit, aggression, patient absconding, early readmission, length of hospital stay, risk factors, personality disorders, bipolar disorder, involuntary admission, hospital bed occupancy, psychiatric hospitalization
MeSH terms
Adult, Aggression, Australia, Female, Humans, Inpatients, Length of Stay, Male, Middle Aged, Patient Care Management, Patient Readmission, Psychiatric Department, Hospital, Risk Factors, Risk Management, Socioeconomic Factors, Odds Ratio, Workload, Age Distribution, Sex Distribution, Health Care Surveys

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