title: Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission.
abstract: BACKGROUND
  Patients admitted to a secure forensic hospital are at risk of a long hospital stay. Forensic hospital beds are a scarce and expensive resource and ability to identify the factors predicting length of stay at time of admission would be beneficial. The DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale are designed to assess need for therapeutic security and urgency of that need while the HCR-20 predicts risk of violence. We hypothesized that items on the DUNDRUM-1 and DUNDRUM-2 scales, rated at the time of pre-admission assessment, would predict length of stay in a medium secure forensic hospital setting.
  
  
  METHODS
  This is a prospective study. All admissions to a medium secure forensic hospital setting were collated over a 54 month period (n = 279) and followed up for a total of 66 months. Each patient was rated using the DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale as part of a pre-admission assessment (n = 279) and HCR-20 within 2 weeks of admission (n = 187). Episodes of harm to self, harm to others and episodes of seclusion whilst an in-patient were collated. Date of discharge was noted for each individual.
  
  
  RESULTS
  Diagnosis at the time of pre-admission assessment (adjustment disorder v other diagnosis), predicted legal status (sentenced v mental health order) and items on the DUNDRUM-1 triage security scale and the DUNDRUM-2 triage urgency scale, also rated at the time of pre-admission assessment, predicted length of stay in the forensic hospital setting. Need for seclusion following admission also predicted length of stay.
  
  
  CONCLUSIONS
  These findings may form the basis for a structured professional judgment instrument, rated prior to or at time of admission, to assist in estimating length of stay for forensic patients. Such a tool would be useful to clinicians, service planners and commissioners given the high cost of secure psychiatric care.
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland. davorem@tcd.ie.|National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. davorem@tcd.ie.
authors.forename: Mary
authors.initials: M
authors.lastname: Davoren
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. orla.byrne@hse.ie.
authors.forename: Orla
authors.initials: O
authors.lastname: Byrne
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland. Paul.OConnell@hse.ie.|National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. Paul.OConnell@hse.ie.
authors.forename: Paul
authors.initials: P
authors.lastname: O'Connell
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland. helen.oneill2@hse.ie.
authors.forename: Helen
authors.initials: H
authors.lastname: O'Neill
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland. oreillk5@tcd.ie.|National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. oreillk5@tcd.ie.
authors.forename: Ken
authors.initials: K
authors.lastname: O'Reilly
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland. kennedh@tcd.ie.|National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. kennedh@tcd.ie.
authors.forename: Harry G
authors.initials: HG
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D005555:Forensic Psychiatry / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014218:Triage / Q000706:statistics & numerical data*; D014754:Violence / Q000706:statistics & numerical data*