Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception

Objective Frequent users of emergency departments (FUED) account for a disproportionate number of emergency department (ED) visits and contribute to a wide range of challenges for ED staff. While several research has documented that case management (CM) tailored to FUED leads to a reduction in ED visits and a better quality of life (QoL) among FUED, whether there is added value for ED staff remains to be explored. This study aimed to compare, among staff in two academic EDs in Switzerland (one with and one without CM), the FUED-related knowledge, perceptions of the extent of the FUED issue, FUED-related work challenges and FUEDs’ legitimacy to use ED. Method Mixed methods were employed. First, ED physicians and nurses (N = 253) of the two EDs completed an online survey assessing their knowledge and perceptions of FUEDs. Results between healthcare providers working in an ED with CM to those working in an ED without CM were compared using independent two-sided T-tests. Next, a sample of participants (n = 16) took part in a qualitative assessment via one-to-one interviews (n = 6) or focus groups (n = 10). Results Both quantitative and qualitative results documented that the FUED-related knowledge, the extent FUED were perceived as an issue and perceived FUEDs’ legitimacy to use ED were not different between groups. The level of perceived FUED-related challenges was also similar between groups. Quantitative results showed that nurses with CM experienced more challenges related to FUED. Qualitative exploration revealed that lack of psychiatric staff within the emergency team and lack of communication between ED staff and CM team were some of the explanations behind these counterintuitive findings. Conclusion Despite promising results on FUEDs’ QoL and frequency of ED visits, these preliminary findings suggest that CM may provide limited support to ED staff in its current form. Given the high burden of FUED-related challenges encountered by ED staff, improved communication and FUED-related knowledge transfer between ED staff and the CM team should be prioritized to increase the value of a FUED CM intervention for ED staff.

Psychiatric staff training in managing medical emergencies: re-audit

AimsIn the UK, people with severe mental illness at a greater risk of poor physical health and have higher premature mortality than the general population, highlighting the importance of responding to physical health problems among patients suffering from psychiatric conditions. However, training for staff on inpatient psychiatric units to meet patients’ physical health needs is sometimes overlooked and has not always been effective.According to NICE Clinical Guideline 25 (2005) and NPSA Rapid Response Report (2008/RRR010), staff on any psychiatric inpatient setting must be capable of monitoring, measurement, and interpretation of vital signs. They must have both adequate information and skills to identify signs indicating worsening of patients’ health and respond effectively to severely ill patients.Hence, we aim to re-audit the results of a similar audit carried out in 2016 to review the level of medical emergency training (in terms of life support training) of clinical staff across the inpatient psychiatric wards at our local hospital - Stepping Hill Hospital- in Stockport.Our hypothesis is that there will be a gap in meeting the required standards for training.MethodA questionnaire including 6 questions (role of the staff member, level of their life support training, when was their training last updated, whether they know the location of the crash trolley, whether they know the local hospital emergency number and whether they should resuscitate the patient if their training is out of date) was given to staff on acute inpatient psychiatric units in Stepping Hill Hospital.ResultThe sample included 49 staff members from all the 3 wards included in the audit. The level of training of nursing staff on the 3 wards was meeting standards except for nursing staff who were new to the wards or coming back to work from prolonged leaves. There was also a gap identified in the level of training of other staff members on the ward as well as on the remaining standards measured by the audit.ConclusionA gap was identified in meeting the required standards of training on the inpatient psychiatric units. Reasons identified for this gap are mainly due to the fact that new or bank staff are asked to cover the wards without providing them with appropriate training and without orientating them about the location of different equipments and policies on the ward.

Psychotische symptomen bij ontregelde insulineafhankelijke diabetes mellitus: gedwongen opname vermijdbaar?

Psychotic symptoms in dysregulated insulin-dependent diabetes mellitus: could coercive hospitalisation have been avoided? This case report describes the medical history of a 64-year-old man brought to the emergency department in a combined psychotic and delirious state due to dysregulated diabetes mellitus (DM). Because of the prominent psychotic symptoms, he was hospitalised in the psychiatric ward. Compliance was compromised as the patient, being under satanic influence, had delusional thoughts of the psychiatric staff. His blood sugar dysregulated further and the patient needed to be transferred to the diabetology department, where he showed good compliance. His blood sugar was regulated and the patient could leave the diabetology department, although the psychotic symptoms persisted. Retransfer to the psychiatric ward was suggested. Because of aggressive acting-out, coercive hospitalisation was proposed. He was transferred to another hospital for a second psychiatric expertise, where he agreed with the proposed antipsychotic treatment and a psychiatric hospitalisation. Consequentially, a coercive hospitalisation was no longer indicated. One day later, he was discharged and the psychotic symptoms resolved shortly after. The correlation between psychosis and dysregulated DM is discussed and the demand for coercive measures re-examined. If the symptoms had been considered as part of an integrated health problem, allowing the patient to continue his stay on the diabetology department, the demand for coercive measures could have been avoided.

The Fixated Threat Assessment Centers

Fixated threat assessment centers (FTACs) have been established in the United Kingdom, Australia, and New Zealand. The model was developed to assess and manage risk from isolated loners who write concerning communications or make problematic approaches to politicians or the British royal family. It has recently been expanded to encompass risks of lone actor grievance-fueled violence more broadly. The essential feature of FTACs is that they are police units jointly staffed by police officers and psychiatric staff from the health service. Given the central role that mental state and motivation play in the assessment of risk, the presence of psychiatric personnel greatly enhances the power of risk assessment and catalyzes multiagency interventions with fixated loners, a population with high psychiatric morbidity. This chapter describes the function, structure, and operating methods of FTACs. The FTACs deal with forms of psychotic pathology rarely seen in psychiatric services, but well described by 19th-century phenomenologists.

Contenção física por bombeiros na agitação psicomotora ou agressividade

Contenção física em quadros de agitação/agressão psicomotora exige habilidades técnicas e emocionais em bombeiros. Verificar frequência e indicações de contenção física em agitação psicomotora ou agressividade pelo Corpo de Bombeiros Militar de Alagoas. Pesquisa quantitativa e descritiva. 427 fichas de atendimentos pré-hospitalares foram analisadas entre dezembro de 2015 e fevereiro de 2016. Análise estatística pelo Statistical Package for Social Science v.23.0, p ≤ 0,05, testes de Qui-quadrado e t de Student para análise de associação entre variáveis. Foram encontrados 52 casos de suspeita ou confirmação de traumas cranioencefálicos ou quadros de emergência psiquiátrica (46,2% destes tiveram agitação psicomotora/agressividade, dos quais 29,2% com contenção física). Contenção física pré-hospitalar está especialmente associada ao atendimento de agitação por quadros psiquiátricos de homens jovens, suporte da polícia, número reduzido de socorristas, e vítimas atendidas conduzidas ao hospital psiquiátrico.Descritores: Agitação Psicomotora, Serviços Médicos de Emergência, Bombeiros. Physical containment by firemen in psychomotor agitation or aggressivenessAbstract: Physical restraint in agitation/psychomotor aggression cases requires technical and emotional skills in firefighters. To verify frequency and indications of physical restraint in psychomotor agitation or aggression by the Military Fire Department of Alagoas. Quantitative and descriptive research. 427 pre-hospital care records were analyzed between December 2015 and February 2016. Statistical analysis using the Statistical Package for Social Science v.23.0, p-value ≤ 0.05, Chi-square, and Student t-tests to analyze the association between variables. 52 cases of suspicion or confirmation of traumatic brain injury or psychiatric emergency cases were found (46.2% of these had psychomotor agitation/aggression, of which 29.2% had physical restraint). Prehospital physical restraint is especially associated with the treatment of agitation by the psychiatric staff of young men, police support, a reduced number of rescuers and victims attended at the psychiatric hospital.Descriptors: Psychomotor Agitation, Emergency Medical Services, Firefighters. Contención física por parte de los bomberos en caso de agitación psicomotriz o agresividadResumen: Restricción física en casos de agitación/agresión psicomotora requiere habilidades técnicas y emocionales en los bomberos. Verificar frecuencia y indicaciones de restricción física en agitación psicomotora o agresión por parte del Cuerpo de Bomberos Militares de Alagoas. Investigación cuantitativa y descriptiva. Se analizaron 427 registros de atención prehospitalaria entre diciembre de 2015 y febrero de 2016. Análisis estadístico utilizando el Paquete Estadístico para Ciencias Sociales v.23.0, p ≤ 0.05, Chi-cuadrado y pruebas de t de Student para analizar asociación entre variables. 52 casos de sospecha o confirmación de lesión cerebral traumática o casos de emergencia psiquiátrica (46,2% de estos tenían agitación/agresión psicomotora, de los cuales 29,2% tenían restricción física). Restricción física prehospitalaria se asocia especialmente con tratamiento de la agitación por parte del personal psiquiátrico de hombres jóvenes, el apoyo policial, número reducido de rescatistas y las víctimas conducido a hospital psiquiátrico.Descriptores: Agitación Psicomotora, Servicios Médicos de Emergencia, Bomberos.

Resources and Workforce in Top-Tier Psychiatric Hospitals in China: A Nationwide Survey

Objectives: Mental healthcare has gained momentum and significant attention in China over the past three decades. However, many challenges still exist. This survey aimed to investigate mental health resources and the psychiatric workforce in representative top-tier psychiatric hospitals in China.Methods: A total of 41 top-tier psychiatric hospitals from 29 provinces participated, providing data about numbers and types of psychiatric beds, numbers of mental health professionals, outpatient services and hospitalization information covering the past 3 years, as well as teaching and training program affiliation.Results: Significant variations were found among participating hospitals and across different regions. Most of these hospitals were large, with a median number of psychiatric beds of 660 (range, 169-2,141). Child and geriatric beds accounted for 3.3 and 12.6% of all beds, respectively, and many hospitals had no specialized child or geriatric units. The overall ratios of psychiatrists, psychiatric nurses, and psychologists per bed were 0.16, 0.34, and 0.03, respectively. More than 40% of the hospitals had no clinical social workers. Based on the government's staffing guidelines, less than one third (31.7%) of the hospitals reached the lower limit of the psychiatric staff per bed ratio, and 43.9% of them reached the lower limit of the nurse per bed ratio.Conclusion: Although some progress has been made, mental health resources and the psychiatric workforce in China are still relatively insufficient with uneven geographical distribution and an acute shortage of psychiatric beds for children and elderly patients. In the meantime, the staffing composition needs to be optimized and more psychologists and social workers are needed. While addressing these shortages of mental health resources and the workforce is important, diversifying the psychiatric workforce, promoting community mental health care, and decentralizing mental health services may be equally important.

When Our Work Hits Home: Trauma and Mental Disorders in Correctional Officers and Other Correctional Workers

Background: International estimates suggest that up to one in three public safety personnel experience one or more mental disorders, including post-traumatic stress disorder (PTSD). Canadian data have been sparse until very recently, and correctional officers and forensic psychiatric staff have rarely been included. Working as a correctional officer is associated with negative health outcomes and increased work-related stress, with several variables affecting reported levels of stress. Healthcare staff also report higher rates of PTSD, especially those who are exposed to aggression in their workplace. In the present study, we compare current symptoms of diverse staff working in correctional occupations.Method: Data were collected from a Canadian national online survey of public safety personnel, including employees of correctional services at the federal level. Correctional officers and wellness services staff were compared for prevalence of mental disorders and suicidal ideation.Results: Correctional officers self-reported statistically significantly more exposure to potentially psychologically traumatic events than wellness services employees. Correctional officers also self-reported higher rates of symptoms of mental disorders, including PTSD, social anxiety, panic disorder, and depression. There were no statistically significant differences in reports of suicidal thoughts, plans, or attempts.Contribution to Society: Correctional and forensic staff contribute to society by working with justice-involved individuals in correctional institutions. Trauma-related disorders and other mental health problems threaten the well-being of correctional and forensic staff. Mental health likely impacts the ability of correctional and forensic staff to develop a therapeutic or working alliance with persons in custody. Staff well-being must be recognized and addressed to ensure that prisoners and staff receive optimal treatment in prison.Conclusion: Our results add to the limited knowledge about the well-being of staff, particularly wellness staff in prisons, who provide daily treatment and care for prisoners with serious mental disorders. Our work is a step toward identifying avenues for promoting staff well-being.