Use of a "secure room" and a security guard in the management of the violent, aggressive or suicidal patient in a rural hospital: a 3-year audit.
BACKGROUND
Little has been published on the management of psychiatric crises in rural areas, and little is known of the security needs or use of "secure rooms" in rural hospitals.


METHODS
We conducted a 3-year retrospective chart audit on the use of our secure room/security guard system at a rural hospital in a town of 3500, located 220 km from our psychiatric referral centre.


RESULTS
Use of our secure room/security guard system occurred at the rate of 1.1 uses/1000 emergency department visits, with the most common indication being physician perception of risk of patient suicide or self-harm. Concern for staff safety was a factor in 10% of uses. Eighty percent of patients were treated locally, with most being released from the secure room after 2 days or less. Fourteen percent of patients required ultimate transfer to our psychiatric referral centre and 6% to a detoxification centre. The average annual cost of security was $16 259.61.


CONCLUSIONS
A secure room can provide the opportunity for close observation of a potentially self-harming patient, additional security for staff and early warning if a patient flees the hospital. Most admissions were handled locally, obviating the need for transfer to distant psychiatric referral centres. Most patients who were admitted were already known as having a psychiatric illness and 80% of the patients required the use of the secure room/security guard system for less than a 2-night stay, suggesting that most rural mental health crises pass quickly.


CONCLUSIONS
Most patients admitted to a rural hospital with a mental health crisis can be managed locally if an adequate secure room/security guard system is available.
Brock
Gordon
G
Centre de Santé de Temiscaming-et-de-Kipawa, Temiscaming, Que. geebee@neilnet.com
Gurekas
Vydas
V
Gelinas
Anne-Fredrique
AF
Rollin
Karina
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression; D014150:Antipsychotic Agents / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D006780:Hospitals, Rural; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D010356:Patient Isolation; D010360:Patient Transfer; D011792:Quebec; D012189:Retrospective Studies; D012637:Security Measures / Q000191:economics; D013405:Suicide / Q000523:psychology*; D014754:Violence; D055815:Young Adult
D014150:Antipsychotic Agents