Boulton Kelsie A, Raghupathy Veena, Guastella Adam J, Bowden Michael R
Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Psychological Medicine, Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, Australia.
J Affect Disord. 2022 May 15;305:1-7. doi: 10.1016/j.jad.2022.02.066. Epub 2022 Feb 25.
In inpatient psychiatric units, seclusion (isolation in a locked room) is recommended only as a last resort for serious aggression or agitation. In response to an increase in seclusion during 2015, an 8-bed child and adolescent inpatient unit implemented a suite of multidisciplinary interventions. This study examines changes in seclusion rates following intervention implementation and assesses whether specific patient factors were associated with seclusion rates before and after interventions.
Multi-modal interventions, comprised of patient treatment plans, intake and handover meetings, staff supervision and debriefing sessions, were implemented from January 2016. We compared quarterly seclusion rates (episodes per 1000 patient days) across a thirteen-year period, from July 2008 to June 2021. Change in seclusion rates following intervention was evaluated using a segmented regression analysis. We examined whether patient factors were associated with seclusion rates, and whether the duration of seclusion episodes differed before and after interventions.
There was a 100% reduction in seclusion rates in the 6 months following intervention implementation, from 28.4 episodes per 1000 patient days in July-September 2015, to 4.7 episodes in January-March 2016, reaching 0.0 episodes by April-June 2016. This reduction was maintained until April-June 2021. Most patients with seclusion events before and after intervention implementation had a neurodevelopmental disorder diagnosis and a minority of patients accounted for most seclusion events. There was a 65% reduction in the average duration of seclusion episodes following interventions, however this was not statistically significant.
Due to a crisis in staff morale, interventions were implemented simultaneously, preventing an understanding of whether a single intervention accounted for change. While not addressed in the current study, assessing perceptions of staff, children and parents following intervention implementation may have elucidated barriers and facilitators to change.
Multidisciplinary, patient-centered interventions may be effective for long-term reduction of seclusion rates in inpatient psychiatric units. These findings highlight patient factors associated with seclusion reduction which should be considered when implementing interventions.
在住院精神科病房，隔离（关在锁着的房间里）仅被推荐作为严重攻击行为或躁动的最后手段。针对2015年隔离情况的增加，一个拥有8张床位的儿童和青少年住院病房实施了一系列多学科干预措施。本研究考察了干预措施实施后隔离率的变化，并评估了特定患者因素在干预前后是否与隔离率相关。
从2016年1月开始实施多模式干预措施，包括患者治疗计划、入院和交接会议、工作人员监督及汇报会。我们比较了2008年7月至2021年6月这13年期间的季度隔离率（每1000个患者日的发作次数）。使用分段回归分析评估干预后隔离率的变化。我们考察了患者因素是否与隔离率相关，以及干预前后隔离发作的持续时间是否不同。
干预措施实施后的6个月内，隔离率降低了100%，从2015年7月至9月每1000个患者日28.4次发作，降至2016年1月至3月的4.7次发作，到2016年4月至6月降至0.0次发作。这一降低一直维持到2021年4月至6月。干预措施实施前后，大多数有隔离事件的患者被诊断患有神经发育障碍，少数患者占了大多数隔离事件。干预后隔离发作的平均持续时间减少了65%，但这在统计学上并不显著。
由于工作人员士气低落的危机，干预措施同时实施，这使得无法了解是否单一干预措施导致了变化。虽然本研究未涉及，但评估干预措施实施后工作人员、儿童和家长的看法可能有助于阐明变化的障碍和促进因素。
多学科、以患者为中心的干预措施可能对长期降低住院精神科病房的隔离率有效。这些发现突出了与减少隔离相关的患者因素，在实施干预措施时应予以考虑。
