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Characteristics of acute wards associated with the presence of a psychiatric intensive care unit, and transfers of patients to it

Published online by Cambridge University Press:  08 June 2012

Len Bowers ,
Natalie Hammond ,
Karen James ,
Alan Quirk ,
Debbie Robson  and
Duncan Stewart
Len Bowers*
Affiliation:
Professor of Psychiatric Nursing Institute of Psychiatry, Kings College London
Natalie Hammond
Affiliation:
Consultant Nurse, Promotion of Safe & Therapeutic Services, South London and Maudsley NHS Foundation Trust
Karen James
Affiliation:
Institute of Psychiatry, Kings College London Research Assistant
Alan Quirk
Affiliation:
Senior Research Fellow, College Centre for Quality Improvement, Royal College of Psychiatrists, UK
Debbie Robson
Affiliation:
Institute of Psychiatry, Kings College London Tutor
Duncan Stewart
Affiliation:
Institute of Psychiatry, Kings College London Research Fellow
*
Correspondence to: Professor Len Bowers, PO Box 30, David Goldberg Building, Institute of Psychiatry, Health Service and Population Research, De Crespigny Park, Denmark Hill, London SE5 8AF. E-mail: [email protected]
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Abstract

Background: Psychiatric intensive care units (PICU) are a potentially expensive component of inpatient services, and exists to care for those patients who cannot be easily contained on ordinary acute wards. However, to date there is little evidence on their efficacy.

Methods: Using data from a previous study of 136 acute psychiatric wards in England (City-128) we examined whether ordinary acute wards having access to a PICU had lower rates of adverse incidents, and modelled behaviours associated with PICU transfer rates.

Results: Controlling for other factors, wards with greater ease of PICU access did not have lower rates of adverse incidents. PICU provision is related in complex ways to the use of seclusion. PICU transfers were associated with seclusion, manual restraint and other severe containment measures, and were triggered by aggression, drug use and absconding.

Conclusions: Transferring patients to a PICU may not be an effective means of reducing adverse incidents on acute wards and may not have appreciable cost benefits. However, PICUs may still produce a range of valued outcomes such as injury reduction, more effective and efficient treatment, greater feelings of security on acute wards, and care for patients within the criminal justice system. Larger and more detailed evaluations using longitudinal data are required.

Keywords

Aggressionoutcomeevaluation
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 8 , Issue 2 , August 2012 , pp. 66 - 77
Copyright
Copyright © NAPICU 2011

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