Search results

In hospitals, several patient flows compete for access to shared resources. Failure to manage these flows result in one or more disruptions within a hospital system. To ensure continuous care delivery, solving flow problems must not be limited to one unit, but should be extended to other departments – a prerequisite for solving flow problems in the entire hospital. Since most current studies focus solely on overcrowding in emergency units, additional insights are needed on system-wide patient flow management. The purpose of this paper is to look at the information available in system-wide patient flow management studies, which were also systematically evaluated to demonstrate which interventions improve inpatient flow.

The authors searched PubMed and Web of Science (Core Collection) literature databases and collected full-text articles using two selection and classification stages. Stage 1 was used to screen articles relating to patient flow management for inpatient settings with typical characteristics. Stage 2 was used to classify the articles selected in Stage 1 according to the interventions and their impact on patient flow within a hospital system.

In Stage 1, 107 studies were selected. Although a growing trend was observed, there were fewer studies on patient flow management in inpatient than studies in emergency settings. In Stage 2, 61 intervention studies were classified. The authors found that most interventions were about creating and adding supply resources. Since many hospital managers these days cannot easily add capacity owing to cost and resource constraints, using existing capacity efficiently is important – unfortunately not addressed in many studies. Furthermore, arrival variability was the factor most frequently mentioned as affecting flow. Of all interventions addressed in this review, the most prominent for advancing patient access to inpatient units was employing a specialized individual or team to maintain patient flow and bed placement across hospital units.

This study provides the first patient flow management systematic overview within an inpatient setting context.

Individuals with intellectual disability (ID), mental health needs and criminal justice system involvement are likely to be admitted to forensic units; however, not all of those individuals are served in that system. It is, therefore, important to understand the profile of those admitted to non‐forensic specialized units for individuals with ID and mental health issues. This paper aims to address this issue.

Demographic, clinical and criminal profiles of individuals discharged over nine years from a specialized dual diagnosis program were reviewed to delineate clinical subgroups.

A total of 20 out of 84 total discharges were identified as having past or current criminal justice system involvement. The most common offence was assault and 60 per cent of these individuals had admissions longer than one year. Subgroups by psychiatric diagnosis differed in their age, legal status, offence history, and length of hospital stay, as well as in therapeutic interventions and discharge process.

The results suggest that inpatients with ID and criminal justice system involvement present with unique treatment, support and risk management needs based on psychiatric diagnosis. The number of individuals in clinical subgroups was low, thus further research is needed to determine if the observed patterns hold true in bigger samples.

The study delineates the complexity and heterogeneity of treatment and supports needs of individuals with intellectual disabilities and offending behaviour.

Sensory modulation is an emerging approach that aims to reduce distress and agitation in mental health service users and potentially avoid the necessity for coercive practices such as seclusion and restraint. Despite the growing use of this intervention, there has been limited research exploring the implementation of sensory modulation at an organisational level, both internationally and within the New Zealand context. The purpose of this study is to investigate the implementation of a sensory modulation programme in two New Zealand inpatient mental health services using an exploratory organisational case study design.

Organisational case study design methodology was used to explore the implementation of a sensory modulation programme in two New Zealand acute adult inpatient mental health services. This study explored how key organisational and staff factors (including policies and practices related to de-escalation and seclusion reduction) influence sensory modulation implementation. Cases were described and examined the pattern of findings.

Strategies found to support implementation were identified at environmental, organisational, group and individual staff levels. Aspects highlighted as being particularly important included taking an inter-professional approach in leadership and training, rostering flexibility and leeway in staffing levels to support training attendance and responsiveness to crises.

The facilitators and strategies highlighted in this study may be used to support the design and implementation of future sensory modulation programmes in New Zealand and internationally.

The complexity of factors that influenced the implementation of the sensory modulation approach within an inpatient setting made determining the effectiveness of the approach challenging. However, the general principles and strategies identified in this study offer useful insights for the design and implementation of future sensory modulation programmes.

This study aims to determine hospital management responses in implementing transformational leadership style, organizational commitment, budget business plan, work motivation, uniqueness of resources, and hospital performance.

The method used in this research is a quantitative research method with a deductive mindset approach. The population in this research is all organizational units under the Regional Public Hospital Dr. Zainoel Abidin with its observation unit. The obtained data will be processed by using inferential statistics, namely Structural Equation Modelling (SEM) by using Smart Partial Least Square (Smart PLS) software.

The overall results of the performance appraisal using the Balanced Scorecard approach seen from the financial, internal business, customer, and training and learning perspectives are right. Regional public Hospital Dr. Zainoel Abidin has provided excellent services, and the performance of its departments has generated the expected outcome and is realized by the hospital.

This research contains some innovation. First, the predictor variables used are transformational leadership, organizational commitment, budget business plans and the implementation of unique resources. Second, the response variable used is a performance in the service industry associated with hospital outpatient units (especially organizational units) and inpatient classes of public hospital hospitals. Third, the research location is at Dr. Hospital. Zainoel Abidin, Indonesia. The combination of the three originalities has never been done in previous studies. The object of research to be examined is hospital management, especially the management of outpatient and inpatient units in hospitals. So far, only employees in business units and educational institutions have been studied, and it only has been partially examined variables that affect leadership, resources, and organizational commitment.

This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs.

The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients.

The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed.

The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs.

This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes.

This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983. This project reviewed all such transfers within one region of England, with an emphasis on differences across levels of security.

Over a six-year period (2010–2016) within one region of England, 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days.

There were substantial delays to urgent hospital transfer across all levels of hospital security. Prisoners were transferred to the following units: medium security (n = 98, 56.9%); psychiatric intensive care units (PICUs) (n = 34, 19.7%); low secure conditions (n = 20, 11.6%); high secure conditions (n = 12, 6.9%); other (n = 9, 5.2%). Mean transfer times were as follows: high secure = 159.6 days; other = 68.8 days; medium secure = 58.6 days; low secure = 54.8 days; and psychiatric intensive care = 16.1 days.

In keeping with the wider literature in this area, transfers of prisoners to hospital were very delayed across all levels of secure psychiatric hospital care. Mean transfer times were in breach of the national 14-day timescale, although transfers to PICUs were quicker than to other units. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved.

This paper extends the available literature on the topic of transferring prisoners with mental illness who require compulsory treatment. There is a small but developing literature in this area, and this paper largely confirms that delays to hospital transfer remain a serious problem in England and Wales. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. This could include different referral and transfer models as a component of service-based and pathways research or combining referral pathways across units to improve their efficacy.

The purpose of this paper is to examine the recovery environment of a sub-acute residential mental health service. Such services are increasingly filling a gap in the continuum of care for people with recurrent mental illness and have a major role supporting the processes of recovery.

A cross-sectional design was used with clients and staff completing the recovery enhancing environment measure. Nine clients who had entered the service from the community (step-up), 18 who had transferred from an inpatient unit (step-down) and ten staff completed the measure.

Clients and staff rated the organisational climate of the service positively, with the role of caring staff being identified as particularly valuable. Clients and staff had similar positive views on the importance of recovery-based elements and rated the service as performing well in these areas. Step-up clients identified performance gaps in the areas of self-management, general health, personal strengths, and personal relationships. Step-down clients identified a range of gaps, including meeting basic needs, empowerment, and fundamental recovery processes.

An assessment of the perceptions of clients and staff can allow services to identify differences in the attitudes of each group and ascertain areas in which the service can be improved to better meet the needs of individual clients. This may include being responsive to the setting from which clients have entered the service.

This is the first study that has examined the recovery environment of a residential mental health service and how it meets the recovery needs of both step-up and step-down admissions.

This paper explores the workforce development issues that arose in the course of an Australian repeat pilot study. The aim of the pilot study was to introduce, within a different setting, a planned approach to the assessment of, and interventions in, emotional states of service users that may lead to episodes of behavioural disturbance within psychiatric units. The pilot study necessitated training of staff in the use of an assessment tool. During the course of the study, a novel element was encountered with regard to staff understanding of service user involvement in treatment. This element, presented here as 'integral self‐intervention', emerged in conjunction with the development of two wall charts: an acute arousal management process chart for staff, and a patient safety chart for service users. The paper will outline the collaborative process towards the partial realisation of this element of integral self‐intervention, and associated workforce development issues.

This study aimed to determine the effect of role conflict and role ambiguity on job satisfaction, self-efficacy and nurses’ adaptability and improvement in service quality by analysis of quality function deployment.

This study used a cross-sectional study design. The research sample of 115 nurses and 299 patients was obtained through the use of probability sampling techniques. Data were statistically analyzed using Spearman’s test to see the correlation between independent and dependent variables. Kruskal–Wallis and one-way ANOVA were used to see the differences and quality function deployment analysis was conducted to improve service quality.

The study concluded there is influence of role conflict and role ambiguity on job satisfaction, self-efficacy and nurses’ adaptability. There are differences in role ambiguity in the inpatient unit, critical room and the emergency room.

The quality of service in the hospital can be improved by evaluating the behavior of nurses on the quality of service perceived by the patient. In addition, the necessary improvement of discipline and commitment between physicians and nurses in improving the quality of services at the hospital.

With this measure, the management of nursing at the hospital can translate patient’s needs into specific plans to produce products and services that bring together the needs of the patient to service quality.

The purpose of this paper is to argue that recent attention has been focused on inpatient services at the expense of community mental health teams and that it is time to redress the balance.

This is a personal viewpoint.

In writing this piece it has enabled us to focus on just how widespread the issues are regarding the lack of focus on community services, and that the view and paradigm needs to change on all levels/structures. Services need to recognise the wide scope of community services and the part they inevitably play in someone’s recovery journey. It also throws the spotlight on services working too often in silos deeply affecting people in receipt of the services.

To stimulate debate about the role of community mental health teams.