title: Milieu improvement in psychiatry using evidence-based practices: the long and winding road of culture change.
abstract: BACKGROUND
  Shorter inpatient stays have resulted in greater patient acuity, making it difficult for patients to heal and challenging for staff to manage.
  
  
  OBJECTIVE
  To improve the milieu for psychiatric inpatients using evidence-based practices.
  
  
  METHODS
  A thorough literature review suggested 18 basic principles to improve patient outcomes while reducing violence, seclusion, restraint, and 1:1 observation. Interventions were multiple, including intensive multi-modal staff education based on the literature review and starting in orientation, introduction of comfort rooms, changes in debriefing practices, careful review of all seclusion and restraint episodes, introduction of integrative modalities, and careful review of all 1:1 observation and review of unit structure.
  
  
  RESULTS
  Multiple interventions resulted in favorable outcomes in the following: rates of seclusion and restraints; time devoted to 1:1 observation, patient and staff satisfaction; violent incidents; and staff and patient injury.
  
  
  CONCLUSIONS
  Long-term culture change toward a more therapeutic milieu can occur as a result implementing evidence-based practices.
authors.affiliation: NewYork-Presbyterian Hospital/Westchester Division, White Plains, NY. Electronic address: lespinos@nyp.org.
authors.forename: Linda
authors.initials: L
authors.lastname: Espinosa
authors.affiliation: NewYork-Presbyterian Hospital/Westchester Division, White Plains, NY. Electronic address: bharris@nyp.org.
authors.forename: Beth
authors.initials: B
authors.lastname: Harris
authors.affiliation: NewYork-Presbyterian Hospital/Westchester Division, White Plains, NY. Electronic address: jof9018@nyp.org.
authors.forename: Joyce
authors.initials: J
authors.lastname: Frank
authors.affiliation: NewYork-Presbyterian Hospital/Westchester Division, White Plains, NY. Electronic address: jam9014@nyp.org.
authors.forename: Julie
authors.initials: J
authors.lastname: Armstrong-Muth
authors.affiliation: NewYork-Presbyterian Hospital/Westchester Division, White Plains, NY. Electronic address: meb9003@nyp.org.
authors.forename: Ellen
authors.initials: E
authors.lastname: Brous
authors.affiliation: NewYork-Presbyterian Hospital/Westchester Division, White Plains, NY. Electronic address: janetmoran3@yahoo.com.
authors.forename: Janet
authors.initials: J
authors.lastname: Moran
authors.affiliation: NewYork-Presbyterian Hospital/Westchester Division, White Plains, NY. Electronic address: jug9010@nyp.org.
authors.forename: Judi
authors.initials: J
authors.lastname: Giorgi-Cipriano
mesh_terms: D055317:Evidence-Based Practice / Q000379:methods*; D006778:Hospitals, Psychiatric; D006801:Humans; D015279:Organizational Culture; D009936:Organizational Innovation; D011570:Psychiatry / Q000379:methods / Q000592:standards; D016896:Treatment Outcome