Triage, decision-making and follow-up of patients referred to a UK forensic service: validation of the DUNDRUM toolkit

BMC Psychiatry

Paul Gilluley³  Faye Blazey²  Neil Boast³  Roz Brown³  Deborah Bull³  Mark Freestone¹ 

[1] Violence Prevention Research Unit, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, Garrod Building, London E1 2AD, UK;Institute of Psychiatry, King’s College, London, UK;East London NHS Foundation Trust, John Howard Centre, London E9 5TD, UK

关键词: Triage;    DUNDRUM;    Admission;    Medium security;    Forensic;   

Others  :  1230266
DOI  :  10.1186/s12888-015-0620-9

 received in 2015-05-15, accepted in 2015-09-30,  发布年份 2015

【 摘 要 】

Background

Forensic medium secure services in the UK are a scarce but essential resource providing care for those in the criminal justice system with severe mental disorder. Appropriate allocation of beds to those most in need is essential to ensure efficient use of this resource. To improve decision-making processes in a UK forensic service, an admissions panel utilized the DUNDRUM 1&2 (D1 & D2) triage instruments.

Methods

Demographic, diagnostic and clinical information on a prospective sample of referrals to a UK adult forensic service was gathered (n = 195). D1 and D2 measures were scored by a panel of clinical managers considering referral information and clinician opinion in reaching their ratings; those not admitted were also followed up.

Results

Within the sample, D1 ratings were predictive of decisions to admit (AUC = .79) and also differentiated between levels of security (F(4) = 16.54, p < .001). Non-admission was not significantly associated with increased risk of offending at follow-up. Items relating to self-harm and institutional behaviour did not show a predictive relationship with the panel decision to admit.

Conclusions

Use of a structured professional judgement tool showing good predictive validity has improved transparency of decisions and appears to be associated with more efficient use of resources, without increased risk to the public.

【 授权许可】

   
2015 Freestone et al.

【 图 表 】

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