Summary
background In an earlier study it was found that aggressive behaviour by patients treated by the psychiatric emergency service could be predicted by the use of a newly developed instrument, the Checklist of Risks/ Crisis team (crc). In this earlier study it was suggested that a replication study, with a larger database, was definitely needed in order to check these findings.
aim To find out in what circumstances patients (aggressive or non-aggressive) make contact with the crisis team and to ascertain the predictive validity of the crc.methods During a period of four years (from 1 January 2006 to 31 December 2009) staff members completed the crc before paying outreach visits to patients experiencing psychiatric crises in the community. In addition, if patients showed any aggressive behaviour during the visit, this was documented by means of the Staff Observation Aggression Scale-Revised (soas-r).
results Our study replicated the earlier finding that the structured clinical risk assessment made on a visual analogue scale (vas) of the crc, together with the additional item about whether there were any potentially dangerous persons in the vicinity of the patient, seem to be useful ‘predictors’ of aggression in the future (with correct classification in respectively 91 and 92%).
conclusion The crc, detailed monitoring of aggressive incidents by means of the soas-r, and the weekly discussions about these incidents all seem to be good instruments for analysing incidents and for increasing the safety of staff members. The methods and techniques introduced at the beginning of the project have gone hand in hand with the reduction in the number of aggressive acts directed at members of the psychiatric emergency service.