Type

Journal Article

Authors

Harry G Kennedy
Ken O'Reilly
Helen O'Neill
Paul O'Connell
Orla Byrne
Mary Davoren

Subjects

Medicine & Nursing

Topics
prospective study therapeutic security length of stay psychiatric care legal status dundrum 2 mental health psychiatry dundrum 1

Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission. (2015)

Abstract Patients admitted to a secure forensic hospital are at risk of a long hospital stay. Forensic hospital beds are a scarce and expensive resource and ability to identify the factors predicting length of stay at time of admission would be beneficial. The DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale are designed to assess need for therapeutic security and urgency of that need while the HCR-20 predicts risk of violence. We hypothesized that items on the DUNDRUM-1 and DUNDRUM-2 scales, rated at the time of pre-admission assessment, would predict length of stay in a medium secure forensic hospital setting. This is a prospective study. All admissions to a medium secure forensic hospital setting were collated over a 54 month period (n = 279) and followed up for a total of 66 months. Each patient was rated using the DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale as part of a pre-admission assessment (n = 279) and HCR-20 within 2 weeks of admission (n = 187). Episodes of harm to self, harm to others and episodes of seclusion whilst an in-patient were collated. Date of discharge was noted for each individual. Diagnosis at the time of pre-admission assessment (adjustment disorder v other diagnosis), predicted legal status (sentenced v mental health order) and items on the DUNDRUM-1 triage security scale and the DUNDRUM-2 triage urgency scale, also rated at the time of pre-admission assessment, predicted length of stay in the forensic hospital setting. Need for seclusion following admission also predicted length of stay. These findings may form the basis for a structured professional judgment instrument, rated prior to or at time of admission, to assist in estimating length of stay for forensic patients. Such a tool would be useful to clinicians, service planners and commissioners given the high cost of secure psychiatric care.
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Full list of authors on original publication

Harry G Kennedy, Ken O'Reilly, Helen O'Neill, Paul O'Connell, Orla Byrne, Mary Davoren

Experts in our system

1
Harry Kennedy
Trinity College Dublin
Total Publications: 22
 
2
Ken O'Reilly
Trinity College Dublin
Total Publications: 6
 
3
Paul O'Connell
Trinity College Dublin
Total Publications: 3
 
4
Mary Davoren
Trinity College Dublin