医院搬迁减少暴力和限制性行为。

Karstoft Beck Louise, Terkildsen Morten Deleuran, Kennedy Harry, Jentz Christian, Harpøth Astrid Jacobsen, Carlsen Anders Helles, Sørensen Lisbeth Uhrskov

Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark.

Psychiatric Hospital, Horsens, Denmark.

Brain Behav. 2025 Sep;15(9):e70760. doi: 10.1002/brb3.70760.

BACKGROUND

Ward design is increasingly recognized as influencing the treatment of psychiatric inpatients. However, evidence on how improved structural surroundings affect aggression and restrictive practices in forensic psychiatry is limited. To our knowledge, no studies have focused on the effect of improved treatment facilities on aggressive behavior and the prescription of restrictive practices among forensic psychiatric inpatients.

AIM

This study aims to explore whether improved architectural design reduces aggression and prescription of restrictive practices in a population of forensic psychiatric inpatients.

METHODS

This retrospective, observational, and longitudinal study included a follow-up 2 years prior and 2 years post relocating the Department of Forensic Psychiatry at Aarhus University Hospital Psychiatry (DFP-AUHP) from an old hospital building to new and purpose-built psychiatric facilities. We included all patients admitted to DFP-AUHP during the study period; 230 unique patients before and 196 unique patients after the relocation. We compared aggression as measured by the Brøset Violence Checklist (BVC) and prescription of restrictive practices prior to and after the intervention. Data were drawn from the Business Intelligence data portal, which routinely stores data from the Electronic Patient File. Statistical analyses were conducted to explore patient demographics, aggression, and the prescription of restrictive practices.

RESULTS

Overall, restrictive practices were more than halved among the included population of forensic psychiatric patients after the relocation (548 to 246, p value: < 0.001). Additionally, the total daily mean BVC, an indicator of aggressive behavior, was significantly lower post-relocation (from 0.40 (95% CI: 0.39-0.42) to 0.27 (95% CI: 0.26-0.28), p value: < 0.001). Both summative data and underlying time trends evidence the results.

CONCLUSION

Our study suggests a significant reduction in aggressive behavior and restrictive practices following the relocation. The study contributes to understanding how environmental changes can relate to patient outcomes and may be relevant for the design and renovation of psychiatric hospital facilities.

TRIAL REGISTRATION

Central Denmark Region: 1-16-02-137-24.

背景

病房设计对精神科住院患者治疗效果的影响日益受到认可。然而，关于改善的结构环境如何影响法医精神病学中攻击行为和限制措施使用情况的证据有限。据我们所知，尚无研究关注改善治疗设施对法医精神病住院患者攻击行为及限制措施处方的影响。

目的

本研究旨在探讨改善的建筑设计是否能减少法医精神病住院患者群体中的攻击行为及限制措施的处方。

方法

本回顾性、观察性纵向研究纳入了奥胡斯大学医院精神病法医科（DFP - AUHP）从旧医院大楼迁至新建的专用精神病设施前后各2年的随访数据。我们纳入了研究期间所有入住DFP - AUHP的患者；搬迁前230例不同患者，搬迁后196例不同患者。我们比较了干预前后用布罗泽特暴力清单（BVC）测量的攻击行为以及限制措施的处方情况。数据来自商业智能数据门户，该门户常规存储电子病历中的数据。进行统计分析以探究患者人口统计学、攻击行为和限制措施的处方情况。

结果

总体而言，搬迁后纳入的法医精神病患者群体中，限制措施的使用减少了一半以上（从548次降至246次，p值：<0.001）。此外，作为攻击行为指标的每日BVC总均值在搬迁后显著降低（从0.40（95%CI：0.39 - 0.42）降至0.27（95%CI：0.26 - 0.28），p值：<0.001）。汇总数据和潜在时间趋势均证实了这一结果。