Mental Health Centre Bavo-Europoort, Rotterdam, and Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands.
Br J Psychiatry. 2011 Dec;199(6):473-8. doi: 10.1192/bjp.bp.111.095141. Epub 2011 Oct 20.
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.
To evaluate the effect of risk assessment on the number of aggression incidents and time in seclusion for patients admitted to acute psychiatric wards.
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.
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.
Routine application of structured risk assessment measures might help reduce incidents of aggression and use of restraint and seclusion in psychiatric wards.
短期结构化风险评估被认为可以减少急性精神病病房的攻击和隔离事件。这种方法的对照研究很少。
评估风险评估对急性精神病病房入院患者攻击事件数量和隔离时间的影响。
在四个病房进行了为期 40 周的集群随机对照试验（n = 597 名患者）。在两个实验组使用结构化风险评估量表，将攻击和隔离事件的数量与两个对照组进行比较，对照组仅基于临床判断进行评估。
实验组的攻击事件数量（相对风险降低 68%，P<0.001）和发生攻击的患者数量（相对风险降低 RRR = -50%，P<0.05）以及隔离时间（RRR = -45%，P<0.05）显著低于对照组。隔离的数量和暴露于隔离的患者数量均没有减少。
常规应用结构化风险评估措施可能有助于减少精神病病房的攻击事件以及约束和隔离的使用。
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