Overcrowding in Psychiatric Wards is Associated With Increased Risk of Adverse Incidents

Teitelbaum, Alexander; Lahad, Amnon; Calfon, Nitza; Gun-Usishkin, Monica; Lubin, Gad; Tsur, Anat

doi:10.1097/mlr.0000000000000501

Cited by 21 publications

(25 citation statements)

References 31 publications

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“…This may be particularly true for patients with dual diagnosis [29]. Moreover, the opening of a ward may reduce the pressure resulting from overcrowding, which is associated with the frequency of violent incidents [30,31]. Ward occupancy was highest during period 3, further supporting such a mechanism.…”

Section: Discussionmentioning

confidence: 71%

Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

et al. 2017

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Objective: Substance use treatment is often performed inside locked wards. We investigate the effects of adopting a policy of open-door treatment for a substance use treatment and dual diagnosis ward. Methods: This is a prospective open-label study investigating 3-month study periods before opening (P1), immediately after (P2), and 1 year after the first period (P3). Data on committed patients, coercion (seclusion, forced medication, absconding events with subsequent police search), violence, and substance use was collected daily. We applied generalised estimating equation models. Results: The mean daily number of patients with ongoing commitment changed from 2.64 (P1) to 2.12 (P2) to 0.96 (P3), corresponding to a reduction of relative risk (RR) for having an ongoing commitment by 20% in P2 (RR 0.80; 95% CI 0.66-0.98) and 67% in P3 (RR 0.33; 95% CI 0.25-0.42). The mean daily number of coercive events was 0.29, 0.13, and 0.05, corresponding to a risk for undergoing coercive measures reduced by 56% (RR 0.44; 95% CI 0.22-0.90) and 85% (RR 0.15; 95% CI 0.05-0.45). Substance use, violence or ward atmosphere did not differ significantly. Conclusions: Our results support findings from general psychiatric wards of reduced coercion after adopting a primarily open-door policy. However, coercive events were rare during all periods. The widespread practice of restricting the freedom of inpatients with substance use disorders by locking ward doors is highly questionable.

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Section: Discussionmentioning

confidence: 71%

Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

et al. 2017

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“…Overcrowding exceeding 10% at the time of an incident has been shown to be associated with violent attacks on staff. A linear trend between more overcrowding and a higher probability of assaults has also been demonstrated (Teitelbaum et al, 2016;Virtanen et al, 2011). Wards and organizations with high patient turnover were also more likely to have high levels of aggressiveness (Bowers et al, 2009).…”

Section: Ward Environment As a Risk Factor And Triggermentioning

confidence: 85%

Risk Factors and Triggers That May Result in Patient-Initiated Violence on Inpatient Psychiatric Units: An Integrative Review

Salzmann‐Erikson

Yifter

2019

Clin Nurs Res

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The aim of the present integrative review is to identify and describe risk factors and triggers that may result in patient-initiated violence on inpatient psychiatric units. Original studies were searched for in PubMed, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature. From the 826 identified publications, 18 were included for a synthesis. The results are presented in three themes, which demonstrate that patient characteristics, staff approach, and the ward environment are influencers that may trigger the emergence of violent incidents. Incidents are discussed from the theoretical framework of complexity science as dynamic, highly variable in manifestation, and adaptive, in that the forthcoming process and outcomes are highly dependent on how the surrounding environment responds. Our recommendation is that staff on inpatient wards recognize the myriad influencers that may trigger inpatient violence in a context of highly complex interactions.

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“…The term may, however, be considered ‘fuzzy’, in that “it is ill-defined, lacks clarity, and is highly difficult to operationalize” ( Koens et al, 2018 , p. 1). While there is not yet a major conceptual framework to understand the term, the academic literature has contributed several theoretical models to better understand the impact of crowding in specific physically defined locations like hospitals and psychiatric hospitals ( Teitelbaum et al, 2016 ; Wang et al, 2017 ), educational institutions ( Graves, 2010 ), or prisons ( Horne & Newman, 2015 ). While these studies have addressed the impact of crowding on participants, they took place in confined involuntary environments that lack consumer choice of participation, like travel or shopping, or hedonistic consumption experiences, as in theme parks.…”

Section: Introductionmentioning

confidence: 99%

Crowded and popular: The two sides of the coin affecting theme-park experience, satisfaction, and loyalty

Milman

Tasci

Wei

2020

Journal of Destination Marketing & Management

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Overcrowding in Psychiatric Wards is Associated With Increased Risk of Adverse Incidents

Abstract: Overoccupancy is prevalent in psychiatric wards and is associated with an increased rate of aggressive AIs and falls. Policy makers should be convinced about the necessity to reduce overcrowding in psychiatric wards and to improve safety of inpatient facilities.

Cited by 21 publications

References 31 publications

Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

Risk Factors and Triggers That May Result in Patient-Initiated Violence on Inpatient Psychiatric Units: An Integrative Review

Crowded and popular: The two sides of the coin affecting theme-park experience, satisfaction, and loyalty

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