Validating Psychometric Properties of a Revised Patient Version of the Combined Assessment of Psychiatric Environments (CAPE).

BACKGROUND: Measuring patient experience is an essential challenge in the inpatient behavioral health population. AIM: This initiative analyzed the psychometric properties of a revised version of the patient Combined Assessment of Psychiatric Environments (p-CAPE-R) survey. METHODS: The p-CAPE was revised to encompass the interdisciplinary treatment team and implemented on five inpatient psychiatric units at an academic medical center. A psychometric analysis was performed on the p-CAPE-R. RESULTS: Analysis of factor loadings with a large sample (n = 786) revealed a more coherent item structure under the "staff competency and engagement" and "treatment effectiveness" domains than presented in the original instrument development research. CONCLUSIONS: Although the p-CAPE-R reflects a more useful and psychometrically sound instrument than the original p-CAPE, further analysis and revision to reflect the entire interdisciplinary team is warranted.

Themes of Worry Among Psychiatric Inpatients That Persist Through Acute Hospitalization.

INTRODUCTION: Problems that worry patients throughout hospitalization are complex and varied, but they fall within the scope of safe, effective, patient-centered care. To our knowledge, there is no evidence describing the problems that worry patients in inpatient psychiatric units. AIM: The purpose of this quality improvement project was to describe common themes of worry experienced by individuals in psychiatric inpatient units in order to improve patient experience. METHOD: This project took place at an urban, safety net hospital at an academic medical center in the northeastern United States between March and December 2019. All patients across five inpatient psychiatric units were offered the Combined Assessment of Psychiatric Environments (CAPE) survey as they approached the end of their stay. RESULTS: A total of 1,800 patients took the survey. Of these patients, 36% (650/1,800) patients responded never/sometimes to "During my hospitalization, I found solutions to problems that worried me," and 46% (297/650) patients provided a response to the follow-up question "What are the problems that worry you the most?" Common themes of worry for inpatient behavioral health patients include (a) life in the hospital, (b) self, and (c) outside life. CONCLUSIONS: Each of these worry themes that emerged from this thematic analysis has implications for behavioral health staff who are preparing the psychiatric/behavioral health inpatient for discharge. These themes can also be used to focus on a variety of quality improvement initiatives to improve the patients experience while in an inpatient psychiatric/behavioral health unit.

Developing and Aligning a Safety Event Taxonomy for Inpatient Psychiatry.

OBJECTIVE: The aim of this project was to develop and align an inpatient psychiatric safety event taxonomy that would blend well-established safety events with psychiatry-specific concerns. METHODS: A hybrid inductive-deductive thematic analysis was used to generate novel descriptive safety event categories for inpatient psychiatry and align these categories with an established taxonomic framework. In the inductive phase, an initial taxonomy was developed by describing the semantic subject and context of reported safety concerns. In the deductive phase, existing literature, national standards, and local content experts were used to align our taxonomy with the safety event measurement system at our institution. RESULTS: A total of 2291 events were extracted and 483 were analyzed. After thorough review, the data was divided into 4 domains: (1) Provision of care, (2) patient actions, (3) environment/equipment, and (4) safety culture. Each domain reflects a mutually exclusive typology of events and provides a parsimonious view of safety concerns in inpatient psychiatry. Each domain was further divided into categories, subcategories, and subcategory details. CONCLUSIONS: Safety events on inpatient psychiatric units are understudied and lack the measurement infrastructure to identify care processes that result in exposure to harm. We develop and align an inpatient psychiatric safety taxonomy based on real-world data, existing literature, and measurement standards. This taxonomy can be used by psychiatric hospitals to improve their patient safety measurement systems-and ultimately-the safety of their patients and communities.

Characteristics of Assaultive Patients Whom Inpatient Psychiatric Staff Report to Law Enforcement.

OBJECTIVE: The authors sought to identify factors that affect hospital staff's decision to pursue criminal charges against patients who assault staff on inpatient psychiatric units. METHODS: Data on assaults occurring on inpatient psychiatric units in one hospital system were collected over 32 months, from November 1, 2016, to July 1, 2019. The events were grouped by whether staff pursued criminal charges after the incident. Descriptive statistics and regression models were used to describe the data and identify predictive variables. RESULTS: Data were reviewed from 9,654 admissions, of which 124 patient encounters involved assaults on staff. Overall, 27 (22%) of 124 assaults on staff resulted in staff pursuing criminal charges. Regression models indicated that criminal history (odds ratio [OR]=2.18, 95% CI=1.26-3.78, p=0.006), age (OR=0.92, 95% CI=0.91-0.94, p<0.001), and diagnosis of chronic mental illness with psychotic symptoms (OR=7.23, 95% CI=1.49-35.04, p=0.01) predicted patient assaults resulting in contact with law enforcement. Several variables were not statistically significantly associated with filing of criminal charges, including race, gender, degree of injury from the assault, number of instances of restraint, and number of as-needed medications. CONCLUSIONS: This is the largest quantitative study to examine the demographic and clinical factors that may play a role in whether staff pursue criminal charges against patients on inpatient psychiatric units. The results suggest that certain patients are more likely to be reported to law enforcement. Institutions should monitor factors that increase the likelihood of assaults on staff resulting in criminal charges and create policies that mitigate discrepancies in criminal justice involvement.

A Visual Dashboard to Monitor Restraint Use in Hospitalized Psychiatry Patients.

BACKGROUND: Restraint events are tracked using a duration rate as part of a national psychiatry quality reporting program and tracked annually. Visual dashboards can help track metrics in near real time but are not routinely used in psychiatric settings. METHODS: This observational study sought to characterize restraint events by extracting electronic medical record data on restraint episodes between January 1, 2017, and December 31, 2019, in five inpatient units in one academic medical center. The data were also used to build a visual dashboard and calculate restraint metrics (duration and frequency) across locations and time. RESULTS: A total of 540 distinct restraint events occurred during the study period. Highest restraint episode counts occurred during evening shift (54.8%), compared to daytime (37.2%) and nighttime (8.0%) shifts. Highest episode duration rates occurred in an adult unit (61.3% of total hours spent in restraints across all units), while highest episode counts occurred in the adolescent unit (48.3% of all restraint episodes). A visual dashboard with two views (summary and detailed) was created. The summary view integrates patient volume data (total patient hours per month) with total duration and number of episodes per month. The detailed view displays event frequency by hour of day, nursing shift, weekday, and patient length of stay at the time of restraint. CONCLUSIONS: Visual dashboards can provide timely and efficient access to granular data elements and metrics related to restraint events, beyond the reporting requirement of a national quality program. Visual dashboards can reveal variations in restraint use and yield important opportunities for clinical quality improvement.

Epidemiology, Infection Prevention, Testing Data, and Clinical Outcomes of COVID-19 on Five Inpatient Psychiatric Units in a large Academic Medical Center.

Inpatient psychiatric facilities can face significant challenges in containing infectious outbreaks during the COVID-19 pandemic. The main objective of this study was to characterize the epidemiology, testing data, and containment protocols of COVID-19 in a large academic medical center during the height of the COVID-19 outbreak. A retrospective cohort analysis was conducted on hospitalized individuals on five inpatient psychiatric units from March 1st to July 8th, 2020. Demographic data collected include age, race, gender, ethnicity, diagnosis, and admission status (one or multiple admissions). In addition, a Gantt chart was used to assess outbreak data and timelines for one unit. Testing data was collected for patients admitted to inpatient psychiatric units, emergency room visits, and employees. 964 individuals were hospitalized psychiatrically. The study population included ethnically diverse patients with various mental illnesses. We also describe infection prevention strategies, screening, and triage protocols utilized to safely continue patient flow during and beyond the study period with a low patient and employee infection rate. In summary, our study suggests that early implementation of triage, screening, extensive testing, and unit-specific interventions can help prevent and contain the spread of COVID-19 in inpatient psychiatric units and help facilitate safe delivery of care during a pandemic.

Contract Negotiation for Neurosurgeons: A Practical Guide.

Contract negotiation is a reality in the career of any neurosurgeon. However, little formal training exists for physicians - including neurosurgeons - on potential techniques and strategies for conducting meaningful contract negotiation. Increasing numbers of neurosurgeons seek hospital employment for which an employment contract will be provided. During contract negotiation, it is likely that a young neurosurgeon will be in discussion with an experienced negotiator acting on behalf of a hospital, practice, or department. Understanding and adapting to this imbalance in experience and using basic negotiating techniques as a means of approaching and resolving key contract issues is critical for the neurosurgeon to maximize his or her value in the course of contract negotiation. Even without formal training in negotiation in residency, negotiation skills can be taught, practiced, and improved. In affiliation with the Medical Director's Ad-Hoc Representational Section of Council of State Neurosurgical Societies (CSNS) this article is intended to serve as a practical guide for contract negotiation. Contract basics, negotiation terms, strategies, unique neurosurgical issues, and value creation are explored.

A searchable database of genetic evidence for psychiatric disorders.

This paper describes a new bioinformatic tool for use in psychiatric research, "SLEP" (Sullivan Lab Evidence Project). SLEP is a searchable archive of findings from psychiatric genetics that is freely available on the web for non-commercial use (http://slep.unc.edu). Via a simple interface, users can retrieve findings from genome-wide linkage, genome-wide association, and microarray studies for ADHD, autism, bipolar disorder, eating disorders, major depression, nicotine dependence, and schizophrenia. Findings can be save to disk or viewed via a genome browser.