Short-term clinical risk assessment and management: Comparing the Brockville Risk Checklist and Hamilton Anatomy of Risk Management.

The current article aims to examine the performance of two brief, dynamic risk measures - the Brockville Risk Checklist (BRC4) and one of two versions of the Hamilton Anatomy of Risk Management [HARM-FV and electronic HARM-FV (eHARM-FV)] - scored at regular clinical case conferences for forensic psychiatric patients in two different settings. The eHARM represents a first-in-class dynamic risk assessment tool using data analytics. Two studies are presented from two forensic psychiatric hospitals in Ontario, Canada. The first study compared the HARM-FV, scored by trained research staff, with the BRC4, scored concurrently by clinical teams, on 36 forensic inpatients. In the second study, trained research staff scored both the BRC4 and the eHARM-FV on 55 forensic inpatients. Both studies demonstrated that the BRC4 and both HARM-FV tools were moderately and positively correlated with each other, with higher agreement for similar domains and items. In both samples, the risk measures performed better at identifying individuals who engaged in repeated or more serious problematic behavior. The HARM-FV and eHARM-FV produced higher area under the curve values for subsequent behavior compared with the BRC4. All three tools were effective at detecting future aggression and adverse incidents. We did not directly compare the HARM-FV and eHARM-FV.

Staff awareness of the application of Mental Health and Guardianship Legislation in the care of hospitalised older persons.

OBJECTIVE: The study aimed to survey hospital staff knowledge of the application of the Mental Health Act 2007 (NSW) (MHA) and the Guardianship Act 1987 (NSW) (GA) in the care and treatment of older persons in a teaching hospital in Sydney. Method Over a two-month period in 2017, a survey questionnaire was distributed to staff involved in older persons' care across the hospital. RESULTS: The majority of the hospital staff demonstrated basic theoretical knowledge of both the GA (76%) and of the MHA (84.5%). Fewer (64.5%) appeared to understand the practical application of the MHA in the hypothetical clinical situations. An even lower proportion of staff appeared to understand the application of the GA either to obtain consent for medical treatment or to appoint a guardian through the Guardianship Division of the NSW Civil and Administrative Tribunal (NCAT). CONCLUSION: Although clinical staff of the hospital displayed fair knowledge and awareness about the application of the MHA and the GA to inpatient care of older adults, further education is necessary, particularly about the application of the GA. The authors suggest similar findings may occur at other New South Wales hospitals, which may raise concern and need for education.

Obtaining consent for non-psychiatric treatment of persons detained under mental health legislation in Australia and New Zealand: is there cross-jurisdictional consistency?

OBJECTIVE: It is increasingly recognised that persons with mental illness experience physical health issues at greater rates than the general population and that there are significant barriers to accessing appropriate treatment. One less obvious barrier to appropriate care may be the law. This review examines the legal regimes within Australia and New Zealand that regulate consent for medical and surgical treatment for persons detained under mental health legislation. The review begins with a brief overview of concepts of consent and capacity then examines the law with regards to consent for non-psychiatric treatment for persons detained in psychiatric facilities. The complexity and cross-jurisdictional consistency is considered and potential future directions and possibilities for reform are discussed. CONCLUSION: Examination of the different laws regarding consent for medical or surgical treatment for persons admitted to psychiatric facilities are complex and demonstrate lack of consistency across jurisdictions. Reform in this area might be considered to achieve greater consistency and clarity for both health professionals and consumers.

Observation Care: Ethical and Legal Considerations for the Emergency Physician.

BACKGROUND: The Medicare observation rules remain controversial despite Centers for Medicare and Medicaid Services revisions and the new 2-midnight rule. The increased financial risks for patients and heightened awareness of the rule have placed emergency physicians (EPs) at the center of the controversy. DISCUSSION: This article reviews the primary ethical and legal (particularly with respect to the Emergency Medical Treatment and Active Labor Act) implications of the existing observation rule for EPs and offers practical solutions for EPs faced with counseling patients on the meaning and ramifications of the observation rule. CONCLUSIONS: We conclude that while we believe it does not violate the intent of the Emergency Medical Treatment and Active Labor Act to respond to patient questions about their admission status, the observation rules challenge the ethical principles of transparency related to the physician-patient relationship and justice as fairness. Guidance for physicians is offered to improve transparency and patient fairness.

Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2016. Final rule.

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2016 as required by the statute. As required by section 1886(j)(5) of the Act, this rule includes the classification and weighting factors for the IRF PPS's case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2016. This final rule also finalizes policy changes, including the adoption of an IRF-specific market basket that reflects the cost structures of only IRF providers, a 1-year phase-in of the revised wage index changes, a 3-year phase-out of the rural adjustment for certain IRFs, and revisions and updates to the quality reporting program (QRP).

Medicare program; extension of the payment adjustment for low-volume hospitals and the Medicare-dependent hospital (MDH) program under the hospital inpatient prospective payment systems (IPPS) for acute care hospitals for fiscal year 2014. Interim final rule with comment period.

This interim final rule with comment period implements changes to the payment adjustment for low-volume hospitals and to the Medicare-dependent hospital (MDH) program under the hospital inpatient prospective payment systems (IPPS) for FY 2014 (through March 31, 2014) in accordance with sections 1105 and 1106, respectively, of the Pathway for SGR Reform Act of 2013.

[Inpatient advocacy under the new system of involuntary hospitalization].

I considered both procedural and substantive requirements for patient advocacy in the context of involuntary hospitalization, and reviewed the revised Act on Mental Health and Welfare for the Mentally Disabled. I concluded that the revised act does not satisfy either procedural or substantive requirements for the advocacy of patients. The revised act stipulates that it be reviewed after three years. Along with carefully monitoring implementation of the new law, we must also create systems for reviewing the introduction of advocators, as well as enhancements to psychiatric review boards.

[A campaign against the law of 1838 governing the status of the mentally ill. Hector Malot, Léopold Turck, Théophile Huc -- a writer, a doctor, a lawyer]. / Une campagne contre la loi de 1838 régissant le statut des aliénés. Hector Malot, Léopold Turck, Théophile Huc, un romancier, un médecin, un juriste.

When Napoleon the 3d's government turned to its liberal phase, dissatisfactions felt free to become visible, among which the problems engendered by the law of 1838 about the situation of mental patients; during the 60s, a novelist, Hector Malot; a doctor, Léopold Turck; a jurist, Théophile Huc, tried to amend it.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the administration of vaccines by nursing staff as well as the CoPs for critical access hospitals relating to the provision of acute care inpatient services. We are finalizing proposals issued in two separate proposed rules that included payment policies related to patient status: payment of Medicare Part B inpatient services; and admission and medical review criteria for payment of hospital inpatient services under Medicare Part A.

Know your HINNs and when to deliver them.

Hospital-Issued Notices of Noncoverage (HINN) inform patients that they will be responsible for the bill if they choose to stay in the hospital when the care they are receiving or about to receive will not be covered by Medicare. If hospitals don't give a HINN when services aren't covered by Medicare, they can't bill patients for services later on. CMS gives hospitals the option of using Condition Code 44 to change a patient's status from inpatient to outpatient to correct an unnecessary admission, then collect payment from Medicare for Medicare Part B services. All HINNs must be signed by the patient and a copy included in their file. If the patient refuses to sign, a copy should be placed in the file with a notation of the refusal to sign.

Do psychiatric inpatients know their rights? A re-audit on information given to inpatients at a London mental health trust about their rights and admission to hospital.

This re-audit assessed whether wards at South West London and St Georges' mental health trust (SWLSTG) met agreed standards regarding informing inpatients about their legal status in hospital and rights, following an initial audit in 2009. Three general adult wards were re-audited, and other general and specialist wards (addictions, eating disorders, deaf services and obsessive compulsive disorder) were added. One hundred and five people (61 informal, 44 detained under the Mental Health Act 1983, revised 2007) on 10 wards were interviewed using an agreed proforma. The re-audit of wards A-C showed improvement: 81.3% of informal inpatients were aware of their legal status, versus 54.2% in 2009 (P = 0.101). Including new wards D-K, 90.2% knew their status (P = 0.0002). Of the informal patients, 65.6% knew they could refuse treatment (P = 0.0184) (on wards A-C, 68.8%, P = 0.105) versus 37.5% in 2009. Despite some improvement, the patient experience of informal admission or detention in hospital still sometimes crosses legal boundaries. This audit highlights the need to improve awareness of patient rights and demonstrated how local presentation of audit improves practice.

Caught in the middle. Under tough scrutiny from the CMS over which patients should be admitted for care, hospitals are frustrated--and patients are fighting back.

As hospitals face growing pressure to reclassify inpatients to "observation" status, patients are the ones being hit with unexpected bills to pay what Medicare won't. One solution to the dilemma is a bill that would restructure the rules on when skilled-nursing care is paid for. "We have very broad-based support," says U.S. Rep. Joe Courtney (D-Conn.), left, one of the House sponsors.

Forensic patients--who is watching them?

Does your hospital security department have the right and/or responsibility for checking out the qualifications and practices of private contractors hired by law enforcement to guard forensic patients? In this article, the author explains why you should.

Decision-making support for inpatients with learning disabilities.

Many people with learning disabilities are able to make their own healthcare decisions, but some lack the mental capacity to do so. This article discusses how the Mental Capacity Act can be used to guide decision-making for people with learning disabilities in hospital, and ensure all decisions are made in the patient's best interests.

Coercion and procedural justice in psychiatric care: state of the science and implications for nursing.

Coercive treatment regimens have increased in variety and intensity over the past decade and include such options as outpatient commitment (OPC) and mental health courts. The intimate involvement of nurses in coerced treatment situations in both inpatient and outpatient settings necessitates a closer examination of its effects. OPC presumably offers greater flexibility and freedom for consumers than lengthy inpatient stays but also extends the state's control over their lives beyond the institution. Although OPC has been shown to decrease rates of rehospitalization and violence, it also is associated with increased levels of perceived coercion. The relationship of the perception of coercion to treatment outcomes is complex and not clearly understood. The goal of OPC is treatment adherence and ultimately increased quality of life, but research has produced conflicting results in those areas. Numerous episodes of OPC may have a cumulative effect on the perception of coercion and contribute to treatment avoidance. However, there is evidence that the perception of coercion can be mitigated by procedural justice that is demonstrated by fairness, patient inclusion in the process, and benevolence on the part of authority figures. Implications for nursing practice and research concerning coercion, procedural justice, and OPC are discussed.

A review of basic patient rights in psychiatric care.

Although patient rights is a concept that all nurse managers need to be aware of, this concept often becomes confusing when applied to patients undergoing psychiatric treatment. It is important for the nurse manager to understand the basic rights that psychiatric patients are entitled to, to best be able to help staff nurses under his/her supervision to protect these rights. The nurse manager on a psychiatric unit often serves as a reference for staff nurses, and even for physicians, when questions regarding patient rights present themselves. The nurse manager should be certain to discuss these issues with the facility's legal and risk management team to be aware of particulars of the law of the state in which the facility is located, as state laws may differ somewhat in their treatment of psychiatric patients.

The vote of acute medical inpatients: a prospective study.

OBJECTIVE: There may be ethical issues associated with allowing certain inpatients to vote as some may be cognitively impaired. During the 2007 elections in France, we conducted a prospective observational study on voting among hospitalized patients. METHOD: Patients hospitalized in an Internal Medicine and Geriatric Department on election day were included. The primary outcome was the turnout among registered inpatients, and secondary outcomes were Mini-Mental State Examination (MMSE) scores and reasons for abstention. RESULTS: Of 142 inpatients (mean age 73 years), 84 were eligible to vote, and 22 actually voted (turnout 25.2%). Among the voters, 23% had an MMSE score of less than 12; 58% of abstentions were procedure-related. DISCUSSION: In our study, some inpatients did not vote as a result of procedural issues. When patients with severe cognitive impairment vote, there is a potential risk of vote diversion. Voting procedures should be improved to give inpatients easier access to the ballot while protecting them from the risk of fraud.

[Are you being served? The inter-organizational status and job perception of those responsible for patient rights in general hospitals in Israel].

BACKGROUND: Paragraph 25 of the Patient's Rights Law in Israel requires that every medical facility director in Israel appoint an Ombudsman who will be responsible for patients' rights, receive patient complaints and resolve them. The law aims to strengthen the patient's position vis-à-vis service providers. Therefore, it is desirable that the Ombudsman shall function independently without apprehension or bias. OBJECTIVES: Eleven years after the law was legislated, the authors researched the following: Were individuals responsible for patient rights appointed in all general hospitals? Who are the position holders? What issues do they deal with? What is the weight of their various responsibilities concerning patient rights, as defined by the law, relative to their other tasks? Do they benefit from organizational mechanisms that assure their independence within the service provider's organization? How do they perceive their job--as "Patient Representatives" (as defined by law), or as representatives of their hospitals? METHODS: Hence, the authors personally interviewed each of the 26 General Hospital Directors in Israel as well as the Ombudsmen in each of their facilities. RESULTS: In each of Israel's general hospitals, an Ombudsman responsible for patient rights was appointed. In the majority of cases (82.6%) the Ombudsman was also engaged in an additional managerial or staff position within the organization. As a result, the Ombudsmen are almost entirely dependent on hospital management. The necessary means, by which to fulfill their positions and responsibilities as defined by the law, such as instructing and guiding medical staff regarding the protection of patient rights, have yet to be put at their disposal. The majority of the Ombudsmen view themselves as management representatives. These perceptions do not agree with the spirit of the Patient's Rights Law which is meant to strengthen the patient's position vis-à-vis medical services providers. The authors found a correlation between these views and the fact that Ombudsmen simultaneously hold additional managerial positions and some see themselves as part of their hospitals senior organizational hierarchy. In addition, we found a correlation between their seniority within the organization and their identification with the organization. CONCLUSIONS: It is recommended that the independence of those responsible for patient rights be strengthened by adding specific stipulations to the law on this matter and that the necessary means needed to fulfill their responsibilities as legislated, be put at their disposal. The authors recommend promoting the independent status of Ombudsmen by not imposing upon them responsibilities other than those for patient rights.