RESUMEN
OBJECTIVE: The clinical practice concerning the use of coercive measures in psychiatry should be compared. METHOD: A common documentation of physical restraint, seclusion, and medication by coercion was introduced among 10 hospitals. RESULTS: 8.4 % of cases treated within the first 6 months of 2004 were exposed to coercive measures with the highest percentage among patients with psychoorganic disorders (32.1 %). The incidence of coercive measures varied highly between different diagnostic groups and hospitals. DISCUSSION: The processing of the large multi-site data sets yields considerable technical problems. Data interpretation should consider confounding factors such as case mix and hospital structure characteristics.
Asunto(s)
Benchmarking/normas , Coerción , Recolección de Datos/estadística & datos numéricos , Hospitales Psiquiátricos/normas , Garantía de la Calidad de Atención de Salud/normas , Gestión de Riesgos/estadística & datos numéricos , Violencia/prevención & control , Estudios Transversales , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Documentación/estadística & datos numéricos , Alemania , Humanos , Trastornos Mentales/epidemiología , Aislamiento de Pacientes/estadística & datos numéricos , Psicotrópicos/administración & dosificación , Indicadores de Calidad de la Atención de Salud/normas , Restricción Física/estadística & datos numéricos , Violencia/psicologíaRESUMEN
OBJECTIVE: To investigate the incidence of coercive measures in standard psychiatric care in different psychiatric hospitals. METHODS: We developed a common documentation of mechanical restraint, seclusion, and medication by coercion, and introduced it in 10 participating hospitals. We developed software able to process the data and to calculate four key indicators for routine clinical use. RESULTS: 9.5% of 36,690 cases treated in 2004 were exposed to coercive measures with the highest percentage among patients with organic psychiatric disorders (ICD-10 F0) (28.0%). Coercive measures were applied a mean 5.4 times per case and lasted a mean 9.7 h each. The incidence and duration of coercive measures varied highly between different diagnostic groups and different hospitals. Use of detailed guidelines for seclusion and restraint was associated with a lower incidence of coercive measures. DISCUSSION: Data interpretation should consider numerous confounding factors such as case mix and hospital characteristics. Suggestions on how to cope with ethical and technical problems in the processing of large multi-site data sets in routine clinical use are made.