title: Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: the Tompkins Acute Ward Study.
abstract: BACKGROUND
  Adverse incidents (violence, self-harm and absconding) can cause significant harm to patients and staff, are difficult to predict, and are driving an increase in security measures and defensive practice.
  
  
  OBJECTIVE
  To explore the relationship between adverse incidents on acute psychiatric wards, admissions and nursing workforce variables.
  
  
  METHODS
  A retrospective analysis of officially collected data covering a period of 30 months on 14 acute wards at three hospitals. This data included 69 serious untoward incidents.
  
  
  RESULTS
  Adverse incidents were more likely during and after weeks of high numbers of male admissions, during weeks when other incidents also occurred, and during weeks of high regular staff absence through leave and vacancy.
  
  
  CONCLUSIONS
  It may be possible to predict adverse incidents. Careful staff management and deployment may reduce the risks.
authors.affiliation: St Bartholomew School of Nursing and Midwifery, City University, London, UK. L.Bowers@city.ac.uk
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
authors.forename: Teresa
authors.initials: T
authors.lastname: Allan
authors.forename: Alan
authors.initials: A
authors.lastname: Simpson
authors.forename: Henk
authors.initials: H
authors.lastname: Nijman
authors.forename: Jonathan
authors.initials: J
authors.lastname: Warren
mesh_terms: D000041:Absenteeism; D000208:Acute Disease; D000328:Adult; D000374:Aggression / Q000523:psychology*; D004739:England; D004924:Escape Reaction; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000451:nursing / Q000523:psychology; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010563:Personnel Turnover; D011567:Psychiatric Department, Hospital; D011618:Psychotic Disorders / Q000453:epidemiology / Q000451:nursing / Q000523:psychology; D012307:Risk Factors; D012308:Risk Management / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000451:nursing / Q000523:psychology; D012931:Social Environment; D013223:Statistics as Topic; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*