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Identifying predictors of adverse outcomes after termination of seclusion in psychiatric intensive care units

Rogers, Jonathan P; Lewis, Gabriella; Lobo, Maria; Wyke, Clementine; Meaburn, Alexander; Harding, Fiona; Garvey, Rebecca; ... Lewis, Glyn; + view all (2024) Identifying predictors of adverse outcomes after termination of seclusion in psychiatric intensive care units. BJPsych Open , 10 (3) , Article e120. 10.1192/bjo.2024.710. Green open access

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Abstract

Background Seclusion is a restrictive practice that many healthcare services are trying to reduce. Previous studies have sought to identify predictors of seclusion initiation, but few have investigated factors associated with adverse outcomes after seclusion termination. Aims To assess the factors that predict an adverse outcome within 24 h of seclusion termination. Method In a cohort study of individuals secluded in psychiatric intensive care units, we investigated factors associated with any of the following outcomes: actual violence, attempted violence, or reinitiation of seclusion within 24 h of seclusion termination. Among the seclusion episodes that were initiated between 29 March 2018 and 4 March 2019, we investigated the exposures of medication cooperation, seclusion duration, termination out of working hours, involvement of medical staff in the final seclusion review, lack of insight, and agitation or irritability. In a mixed-effects logistic regression model, associations between each exposure and the outcome were calculated. Odds ratios were calculated unadjusted and adjusted for demographic and clinical variables. Results We identified 254 seclusion episodes from 122 individuals (40 female, 82 male), of which 106 (41.7%) had an adverse outcome within 24 h of seclusion termination. Agitation or irritability was associated with an adverse outcome, odds ratio 1.92 (95% CI 1.03 to 3.56, P = 0.04), but there was no statistically significant association with any of the other exposures, although confidence intervals were broad. Conclusions Agitation or irritability in the hours preceding termination of seclusion may predict an adverse outcome. The study was not powered to detect other potentially clinically significant factors.

Type: Article
Title: Identifying predictors of adverse outcomes after termination of seclusion in psychiatric intensive care units
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1192/bjo.2024.710
Publisher version: http://dx.doi.org/10.1192/bjo.2024.710
Language: English
Additional information: © The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/ licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited
Keywords: Science & Technology, Life Sciences & Biomedicine, Psychiatry, Seclusion, psychiatric intensive care unit, violence, aggression, IMMINENT AGGRESSION, DYNAMIC APPRAISAL, PATIENT CHARACTERISTICS, SITUATIONAL AGGRESSION, DURATION, DECISION, RISK
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry > Institute of Mental Health
URI: https://discovery.ucl.ac.uk/id/eprint/10195491
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