Abstract
BackgroundPatients 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.MethodsThis 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.ResultsDiagnosis 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.ConclusionsThese 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.
Highlights
Patients admitted to a secure forensic hospital are at risk of a long hospital stay
The aim of this study is to examine whether or not scores on the items of the DUNDRUM-1 triage security and the DUNDRUM-2 triage urgency scales rated at the time of pre-admission assessment, would predict length of stay in a forensic hospital setting as expected [41] based on cross-sectional data [32, 41] and prospective data [44]
Patients who had been on the waiting list for the Central Mental Hospital for some weeks prior to admission may have had several DUNDRUM-2 triage urgency scales completed during that time and the most recent DUNDRUM-2 triage urgency scale that was completed prior to the date of admission was used for the purposes of this study
Summary
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 second can be addressed by ensuring that the individual care and treatment plan and the recovery pathway from higher to lower levels of therapeutic security and eventual restoration of autonomy is guided by treatment programmes relevant to needs derived from the seriousness [4, 5] and probability [6, 7] of the risks the person presents. This can be addressed using risk assessment and needs assessment instuments in combination with more specific assessments of treatment outcome and recovery [8, 9]. This paper set out to identify risk factors for longer lengths of stay in secure forensic hospital care, so that length of stay can be actively managed from the outset
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