title: Moving to a purpose built acute psychiatric unit on a general hospital site--does the new environment produce change for the better?
abstract: The environment of a hospital can have a significant impact on the experiences of patients. In March 2003 a new purpose built acute psychiatric admission unit opened on the site of Kilkenny General hospital, while the admission wards of the 2 local stand-alone psychiatric hospitals closed. We sought to compare admissions before and after the move, hypothesising that there would be lower levels of aggression, sedative prescribing and intoxicant abuse in the new unit. Details of 98 acute admissions that occurred during the first 3 months of 2002 were compared to 97 acute admissions that occurred during the first 3 months of 2004. Average daily diazepam and chlorpromazine equivalents were calculated for each patient. The Modified Overt Aggression Scale (MOAS) was used to compare levels of aggression. Compared to 2002 fewer patients left the hospital against medical advice in 2004 (OR 0.35, p = 0.027). Overall levels of aggression fell significantly (p = 0.001). Levels of benzodiazapine prescribing also fell (Mean diazepam daily dose 5.75 mg in 2002 versus 4.14 mg in 2004; p = 0.003). There were trends towards reductions in involuntary admissions, admissions of intoxicated people, patients abusing intoxicants in hospital and in antipsychotic prescribing. It is likely that the more pleasant, better designed and less stigmatising environment of the new unit together with the renewed energy and optimism of clinical staff contributed to the changes observed.
authors.affiliation: Department of Adult Psychiatry, Cluain Mhuire Mental Health Services, Blackrock, Co. Dublin. larkinfeeney@gmail.com
authors.forename: L
authors.initials: L
authors.lastname: Feeney
authors.forename: A
authors.initials: A
authors.lastname: Kavanagh
authors.forename: B D
authors.initials: BD
authors.lastname: Kelly
authors.forename: M
authors.initials: M
authors.lastname: Mooney
mesh_terms: D000208:Acute Disease; D000328:Adult; D000374:Aggression / Q000187:drug effects / Q000523:psychology*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D017723:Drug Utilization Review; D005260:Female; D006272:Health Facility Environment; D006749:Hospital Design and Construction; D006769:Hospitals, General; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007494:Ireland; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives