Subject(s)
Case Management , Managed Care Programs/economics , Psychiatric Department, Hospital/statistics & numerical data , Correspondence as Topic , Inpatients , Insurance Coverage , Length of Stay , Managed Care Programs/organization & administration , Massachusetts , Models, Organizational , Patient Admission , Psychiatric Department, Hospital/economics , Psychiatric Department, Hospital/standards , Quality of Health CareABSTRACT
The suicide of a patient is not an infrequent event in a psychiatrist's practice, and it has a major impact on the clinician as well as on the patient's family and the hospital staff. Dealing with a patient's suicide is a neglected topic in residency training, and many psychiatrists are never taught how to cope with such a situation. The authors review the relevant literature and draw on this as well as on their own clinical experience to recommend specific interventions. They point out that the psychiatrist has a leadership role and a number of responsibilities in the aftermath of a suicide, including notifying the family, the hospital staff, hospital officials, and patients who knew the deceased patient; meeting with the family, the staff, and the patients to encourage discussion and venting of feelings; attending the funeral; and accurately documenting events in the medical record. The psychiatrist should also attend to his or her own needs by seeking support from a colleague and should ensure that a psychological autopsy is performed in order to facilitate learning, improve care of patients in the future, and help bring about closure for the psychiatrist so that the quality of his or her care of other patients is not compromised.
Subject(s)
Mental Disorders/psychology , Physician's Role , Psychiatry/standards , Suicide , Attitude of Health Personnel , Communication , Forensic Psychiatry , Funeral Rites , Humans , Medical Records , Medical Staff, Hospital , Physician-Patient Relations , Professional-Family Relations , Risk Management , Social Responsibility , Suicide/psychologyABSTRACT
In order for a quality assurance program to achieve its goal of true quality improvement, it must function in full partnership with the entire treatment team as a collaborative discipline. It must actively contribute to the care by not only developing effective studies and reports on treatment but also must share these results in an educational, timely, relevant, and individualized manner. This article offers a number of specific methods to enhance staff involvement and participation in quality assurance and describes a series of collaborative approaches and techniques to promote their collaboration.
Subject(s)
Interprofessional Relations , Quality Assurance, Health Care , Emergency Service, Hospital/standards , Feedback , HumansABSTRACT
The clinical chart constitutes an evolving patient care document. This article compares charts from the turn of the century with those of today. It has changed from a simple user-friendly personal note record to a major medical-legal documentation system. With this evolution have come shifts in clinicians' attitudes toward the chart, a more active role in influencing care for the record, a much more public position of it, and a more homogenized record. It concludes with methods for the practitioners to incorporate the evolving chart into their work so as to further improve their documentation and care.
Subject(s)
Medical Records , Confidentiality , Humans , Medical Records/standards , Quality of Health Care , Social ChangeABSTRACT
This article details the specific cases and situations in which home treatment has proved particularly appropriate and effective. It suggests that for certain patients, home treatment has become the treatment of choice.
Subject(s)
Home Care Services , Home Nursing , Mental Disorders/therapy , Aged , Agoraphobia/therapy , Anxiety Disorders/therapy , Combined Modality Therapy , Depressive Disorder/therapy , Family Therapy , Female , Hospitalization , Humans , Male , Mental Disorders/psychology , Middle Aged , Panic , Patient Care Team , Sick Role , Social Isolation , Stress Disorders, Post-Traumatic/therapyABSTRACT
In addition to preventing or shortening psychiatric hospitalization, home psychiatric treatment allows family collaborative therapy, crisis resolution, therapy for nonresponders to hospitalization, treatment of family members other than the identified patient, work with the entire environment, treatment of patients with both medical and psychiatric disorders, work with the elderly, and educational advantages for medical students and residents. The author believes that home treatment is the treatment of choice in cases where family dynamics have a major role, preserving the patient's autonomy is paramount, and hospitalization would be deleterious.
Subject(s)
Home Care Services/organization & administration , Mental Disorders/therapy , Adolescent , Adult , Aged , Crisis Intervention , Family Practice/education , Family Therapy , Female , Humans , Internship and Residency , Male , Middle Aged , Patient Care Team , Psychiatry/education , Students, MedicalABSTRACT
There is a considerable range of mutual interests between the disciplines of family practice and psychiatry. Each field has much to offer and receive from collaborative activities in teaching programs, particularly at the level of residency training. This paper describes the goals, content, methods, and initial experience of a one-month family practice rotation on a psychiatric service with a focus on Emergency and Consultation-Liason Psychiatry.
Subject(s)
Family Practice/education , Personnel Management , Personnel Staffing and Scheduling , Psychiatric Department, Hospital , Emergency Service, Hospital , Humans , Internship and Residency , Referral and Consultation , WorkforceABSTRACT
A community mental health center operates a psychiatric consultation program as an integral part of the medical emergency service of a 550-bed general hospital. A major advantage of the system is that it allows the hospital to provide immediate comprehensive services--psychiatric as well as medical--to emergency patients. The consultation program also accepts referrals of hospitalized medical patients with apparent emotional problems and referrals of patients from such sources outside the hospital as pediatricians, clergymen, and other community agencies.
Subject(s)
Community Mental Health Services , Hospitals, General , Referral and Consultation , Clergy , Emergency Services, Psychiatric , Humans , Interprofessional RelationsSubject(s)
Life Change Events , Mother-Child Relations , Adult , Attitude , Child, Preschool , Decision Making , Depression/etiology , Female , Humans , Marriage , Psychophysiologic Disorders , Women's RightsABSTRACT
The paper describes the changes produced in the practice of dynamic psychotherapy when conducted within a circumscribed region. The authors discuss changes in anonymity, roles, and transference relationships for both therapist and patient. The paper demonstrates these effects on the therapist's professional training, his practice, and his family.
Subject(s)
Professional-Patient Relations , Psychotherapy , Social Environment , Attitude of Health Personnel , Countertransference , Humans , Role , Social Perception , Socialization , Transference, PsychologyABSTRACT
A staff nurse on a psychiatric inpatient unit committed suicide. A retrospective study of patients and staff reactions was conducted. It showed that the inpatients dealt openly and effectively with grieving. Staff had a great deal of difficulty with the situation. One of the nurse's outpatients required rehospitalization. Recommendations for more attention to the staff mourning process were made.
