Aggression and seclusion on acute psychiatric wards: effect of short-term risk assessment.
BACKGROUND
Short-term structured risk assessment is presumed to reduce incidents of aggression and seclusion on acute psychiatric wards. Controlled studies of this approach are scarce.


OBJECTIVE
To evaluate the effect of risk assessment on the number of aggression incidents and time in seclusion for patients admitted to acute psychiatric wards.


METHODS
A cluster randomised controlled trial was conducted in four wards over a 40-week period (n = 597 patients). Structured risk assessment scales were used on two experimental wards, and the numbers of incidents of aggression and seclusion were compared with two control wards where assessment was based purely on clinical judgement.


RESULTS
The numbers of aggressive incidents (relative risk reduction -68%, P<0.001) and of patients engaging in aggression (relative risk reduction RRR = -50%, P<0.05) and the time spent in seclusion (RRR = -45%, P<0.05) were significantly lower in the experimental wards than in the control wards. Neither the number of seclusions nor the number of patients exposed to seclusion decreased.


CONCLUSIONS
Routine application of structured risk assessment measures might help reduce incidents of aggression and use of restraint and seclusion in psychiatric wards.
Mental Health Centre Bavo-Europoort, Rotterdam, and Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands. r.vandesande@parnassiabavogroep.nl
R
R
van de Sande
H L I
HL
Nijman
E O
EO
Noorthoorn
A I
AI
Wierdsma
E
E
Hellendoorn
C
C
van der Staak
C L
CL
Mulder
D000208:Acute Disease; D000328:Adult; D000374:Aggression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D009426:Netherlands; D015397:Program Evaluation; D011567:Psychiatric Department, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D011568:Psychiatric Nursing; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012934:Social Isolation; D013997:Time Factors; D014754:Violence / Q000517:prevention & control* / Q000523:psychology / Q000706:statistics & numerical data