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

BMC Psychiatry

Research Article

Helen O’Neill¹  Paul O’Connell²  Mary Davoren²  Harry G. Kennedy²  Ken O’Reilly²  Orla Byrne³ 

[1] Department of Psychiatry, Trinity College Dublin, Dublin, Ireland;Department of Psychiatry, Trinity College Dublin, Dublin, Ireland;National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland;National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland;

关键词: Forensic;    Hospital;    Length of stay;    Prediction;    DUNDRUM toolkit;   

DOI  :  10.1186/s12888-015-0686-4

 received in 2015-08-12, accepted in 2015-11-19,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPatients 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.MethodsThis 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.ResultsDiagnosis 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.ConclusionsThese 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.

【 授权许可】

CC BY   
© Davoren et al. 2015