ABSTRACT
BACKGROUND: Staff injuries adversely affect the health of staff members as well the ability of health care teams to effectively care for patients. Identifying patients who pose an increased risk of injury may allow for the planning of risk mitigation strategies, but few studies have examined patient factors associated with staff injury risk. AIMS: Examine the relationship between staff injury and patient mobility, which has been linked to other key hospital outcomes. METHODS: Linking occupational health and electronic medical record data, we examined documented patient mobility levels, based on the Activity Measure for Post-Acute Care (AM-PAC) and the Johns Hopkins Highest Level of Mobility (JH-HLM) Scale, on the day prior to injury. In addition, we created a matched cohort of control patients not associated with staff injury to examine the influence of patient mobility on the odds of staff injury. RESULTS: We identified 199 staff injuries associated with 181 patients with 1063 matched controls. Patients had median scores of 11 and 3 on the AM-PAC and JH-HLM, respectively, indicating moderate-severe mobility impairments. In addition, scores in the lowest AM-PAC tertile (6-15) and lowest JH-HLM tertile (1-4) were associated with a 4.46-fold and 2.90-fold increase in the odds of nurse injury, respectively. CONCLUSIONS: These results indicate that moderate-severe mobility impairments are associated with increased risk of nurse injury. Hospitals and clinical care teams should consider documenting mobility routinely and utilizing these values to identify patients who pose an increased risk of nurse injury.
Subject(s)
Hospitals , Mobility Limitation , HumansABSTRACT
OBJECTIVE: Patients with affective disorders are at high risk of suicide, especially during inpatient treatment and during the first year after discharge. METHODS: A blinded case-control design was used. The study included a total national sample of patients with affective disorder admitted during the period from January 1, 1994 to December 31, 1995, who died because of suicide, either during admission or shortly after discharge. RESULTS: A history of suicide attempt was a significant risk factor (IRR 4.9; 95% CI 2.1-11.6). Loss of job during the year prior to the index admission was associated with an increase in suicide risk (IRR: 2.9; 95% CI 1.2-7.5). Clinical improvement during the index admission (IRR: 0.3; 95% CI 0.1-0.7), and treatment with antidepressant drugs at the censoring date (IRR: 0.3; 95% CI 0.1-0.7) were associated with a decrease in suicide risk. CONCLUSION: Improved treatment may be a key factor in suicide prevention in patients during, and shortly after hospitalisation with affective disorders. Also, there is a need to be especially aware of suicide risk in patients with little or no improvement at discharge.
Subject(s)
Bipolar Disorder/mortality , Depressive Disorder, Major/mortality , Inpatients/statistics & numerical data , Patient Discharge/statistics & numerical data , Suicide/statistics & numerical data , Adult , Antidepressive Agents/therapeutic use , Bipolar Disorder/diagnosis , Bipolar Disorder/psychology , Case-Control Studies , Cross-Sectional Studies , Denmark , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Female , Humans , Inpatients/psychology , Life Change Events , Male , Middle Aged , Risk Factors , Socioeconomic Factors , Suicide/psychology , Suicide, Attempted/psychology , Suicide, Attempted/statistics & numerical data , Unemployment/psychology , Unemployment/statistics & numerical dataABSTRACT
UNLABELLED: The aim of this study was to identify risk factors for suicide related to the course of treatment. METHODS: All persons in Denmark hospitalised for the first time because of an affective disorder during the period 1973-1993 were included. RESULTS: In 53466 patients, suicide was the cause of death in 3141 (6%) cases. The risk of suicide was high both immediately after admission and immediately following discharge. Increased risk was also associated with short duration of affective disorder, a history of multiple admissions, male gender, and increasing age. LIMITATIONS: We were not able to distinguish with certainty between manic and depressive episodes in bipolar disorder. Prior suicide attempts could not be included in the analyses. Lack of operationalised diagnostic criteria. CONCLUSIONS: Patients hospitalised because of an affective disorder are a highly relevant target group for suicide prevention. There is a need for improvement of preventive measures during admission and at discharge. Likewise, there is a need for preventive measures which can minimize the risk of relapse in affective disorders.
Subject(s)
Mood Disorders/complications , Mood Disorders/psychology , Registries/statistics & numerical data , Suicide, Attempted , Adolescent , Adult , Aged , Aged, 80 and over , Denmark , Female , Hospitals, Psychiatric , Humans , Inpatients , Male , Middle Aged , Risk FactorsABSTRACT
BACKGROUND: The high mortality from suicide in patients admitted to hospital with an affective disorder is well documented, although specific causes of mortality and changes in mortality are less well studied. AIMS: To describe the pattern of mortality in patients with affective disorder and to study changes in suicide risk during the study period. METHOD: All patients (n = 54,103) admitted for the first time to a psychiatric hospital in Denmark during the period 1973-1993 because of affective disorder were included in this study. The mortality rate was compared with that of the general population. RESULTS: Mortality from natural and unnatural causes was elevated in all subgroups of affective disorder. The risk of suicide among patients ill for one year or less after first admission increased during the period 1973-1993. CONCLUSIONS: More attention should be paid to the risk of suicide and to physical illness in patients with affective disorders.
