Observation levels in acute psychiatric admissions

  • M. Langenbach
  • Ola Junaid
  • Christine M. Hodgson-Nwaefulu
  • Joanne Kennedy
  • Stephen R. Moorhead
  • Paloma Ruiz
Original paper

DOI: 10.1007/s004060050062

Cite this article as:
Langenbach, M., Junaid, O., Hodgson-Nwaefulu, C. et al. European Archives of Psychiatry and Clinical Neurosciences (1999) 249: 28. doi:10.1007/s004060050062

Abstract

It was our objective to compare the influence of patients’ variables and circumstances of admission on the use of observation levels in acute psychiatric admissions in a British mental health unit. We performed a prospective case note survey of all acute psychiatric admissions during 28 consecutive days in June and July 1991 within a large teaching hospital and a traditional psychiatric hospital in Nottingham, England. We compared, the demographic characteristics of 88 consecutive admissions, admission procedures, clinical data, initial observation levels and changes in observation levels. As for the results, most patients were admitted outside of regular working hours (weekends or after 5 p.m.). Most patients were placed on intermediate (close) observation. The most important factor associated with the choice of observation level was the legal status of the patient (χ2 = 14.79, df = 2, p < 0.001, Fisher’s exact test p < 0.0001). There were significantly fewer incidents (χ2 = 7.72, df = 2, p < 0.05, Fisher’s exact test p < 0.01) on the highest (special) category of observation. The observation policy of the unit was not followed consistently. The number of factors contributing to the choice of observation levels reflects the complexity of the task facing the staff. Special observation is an effective method of managing acutely disturbed patients. The time of admission of most patients implies that more trained staff should be provided outside of regular hours. Clinical staff should be regularly trained in the use of observation procedures. It should be a regular topic in clinical audit.

Key words Dangerous behaviour Hospital patient relations Psychiatric hospitals Risk assessment Suicide 

Copyright information

© Steinkopff Verlag 1999

Authors and Affiliations

  • M. Langenbach
    • 1
  • Ola Junaid
    • 2
  • Christine M. Hodgson-Nwaefulu
    • 3
  • Joanne Kennedy
    • 5
  • Stephen R. Moorhead
    • 4
  • Paloma Ruiz
    • 6
  1. 1.Department of Psychosomatics and Psychotherapy, University of Cologne, D-50924 Köln, Germany e-mail: michael.langenbach@medizin.uni-koeln.de, Tel.: 0221-478-4298, Fax: 0221-478-3103DE
  2. 2.St. Francis Unit, City Hospital, Sherwood, Nottingham NG5 1PB, EnglandGB
  3. 3.Briary Wing, Harrogate District Hospital, Lancaster Park Road, Harrogate HG2 7SX, EnglandGB
  4. 4.Department of Psychiatry, University of Newcastle-upon-Tyne, Royal Victoria Infirmary, Newcastle-upon-Tyne NE1 4LP, EnglandGB
  5. 5.Child and Family Psychiatry, The Mill, Lodge Lane, Derby DE1 3HB, EnglandGB
  6. 6.Polyklinik, Psychiatrisch Zentrum, Bloomendaal, 2500 NA Den Haag, The NetherlandsNL

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