title: Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial.
abstract: BACKGROUND
  There is a lack of research on the possible contribution of a structured risk assessment to the reduction of aggression in psychiatric in-patient care.
  
  
  OBJECTIVE
  To assess whether such risk assessments decrease the incidence of violence and coercion.
  
  
  METHODS
  A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm. The intervention comprised a standardised risk assessment following admission with mandatory evaluation of prevention in high-risk patients.
  
  
  RESULTS
  Incidence rates decreased substantially in the intervention wards, whereas little change occurred in the control wards. The adjusted risk ratios suggest a 41% reduction in severe aggressive incidents and a 27% decline in the use of coercive measures. The severity of aggressive incidents did not decrease.
  
  
  CONCLUSIONS
  Structured risk assessment during the first days of treatment may contribute to reduced violence and coercion in acute psychiatric wards.
authors.affiliation: Nursing and Social Education Research Unit, University Bern Psychiatric Services, Bolligenstrasse 111, Berne 60, Switzerland. Abderhalden@puk.unibe.ch
authors.forename: Christoph
authors.initials: C
authors.lastname: Abderhalden
authors.forename: Ian
authors.initials: I
authors.lastname: Needham
authors.forename: Theo
authors.initials: T
authors.lastname: Dassen
authors.forename: Ruud
authors.initials: R
authors.lastname: Halfens
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Haug
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression; D003068:Coercion; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000451:nursing* / Q000523:psychology; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014754:Violence / Q000517:prevention & control* / Q000706:statistics & numerical data