Work

East London Modified-Broset as Decision-Making Tool to Predict Seclusion in Psychiatric Intensive Care Units

Year: 2017

Type: article

Abstract: Seclusion is a last resort intervention for management of aggressive behavior in psychiatric settings. There is no current objective and practical decision-making instrument for seclusion use on psychiatric wards. Our aim was to test the predictive and discriminatory characteristics of the East London Modified-Broset (ELMB), to delineate its decision-making profile for seclusion of adult psychiatric patients, and secondly to benchmark it against the psychometric properties of the Broset Violence Checklist (BVC). ELMB, an 8-item modified version of the 6-item BVC, was retrospectively employed to evaluate the seclusion decision-making process on two Psychiatric Intensive Care Units (PICUs) (patients n = 201; incidents n = 2187). Data analyses were carried out using multivariate regression and Receiver Operating Characteristic (ROC) curves. Predictors of seclusion were: physical violence towards staff/patients OR = 24.2; non-compliance with PRN (pro re nata) medications OR = 9.8; and damage to hospital property OR = 2.9. ROC analyses indicated that ELMB was significantly more accurate that BVC, with higher sensitivity, specificity, and positive likelihood ratio. Results were similar across gender. The ELMB is a sensitive and specific instrument that can be used to guide the decision-making process when implementing seclusion.

Source: Frontiers in Psychiatry

DOI: 10.3389/fpsyt.2017.00194

Authors: Felice Loi, Karl Marlowe

Institutions: Queen Mary University of London, East London NHS Foundation Trust, Mile End Hospital

Language: English

Topic: Healthcare Decision-Making and Restraints

Subfield: Clinical Psychology

Field: Psychology

Domain: Social Sciences

SDGs: Good health and well-being, Peace, justice, and strong institutions

Open Access status: gold

Estimated APC paid: $3,801