Table 1
Interview themes per participating physicians.
| DISCUSSED ITEM | QUALITY OF CARE | JOB SATISFACTION | SAFETY | COLLABORATION | STIGMATIZATION | LEARNING ENVIRONMENT |
|---|---|---|---|---|---|---|
| Psychiatrist 1 | 1 | 0 | 1 | 1 | 1 | 0 |
| Psychiatrist 2 | 1 | 1 | 0 | 1 | 0 | 0 |
| Psychiatrist 3 | 1 | 1 | 0 | 1 | 1 | 0 |
| Psychiatrist 4 | 1 | 0 | 1 | 1 | 1 | 1 |
| Vascular Surgeon | 1 | 1 | 0 | 1 | 0 | 0 |
| Oncology surgeon | 1 | 0 | 1 | 1 | 0 | 0 |
| Intensivist | 1 | 1 | 0 | 1 | 0 | 1 |
| Internist | 1 | 1 | 1 | 1 | 0 | 1 |
| Endocrinologist | 1 | 0 | 1 | 1 | 0 | 0 |
| Trauma surgeon | 1 | 1 | 1 | 0 | 0 | 0 |
| Total | 10 | 6 | 6 | 9 | 3 | 3 |
Table 2
Patient characteristics, referring specialties and diagnoses, November 2020 to May2021.
| CHARACTERISTICS | MPU N = 31 | PCS N = 31 |
|---|---|---|
| Male | 54.8% | 74.2% |
| Mean Age in years (range) | 49.52 (24–83) | 54.35 (19–74) |
| Referring specialties | ||
| (Acute) internal medicine | 8 | 6 |
| Neurology | 5 | 2 |
| Surgery | 5 | 0 |
| Cardiology | 3 | 4 |
| Neurosurgery | 2 | 6 |
| Nephrology | 1 | 0 |
| Otorhinolaryngology | 1 | 0 |
| Pulmonology | 1 | 4 |
| Dermatology | 1 | 0 |
| Oncology | 1 | 2 |
| Endocrinology | 1 | 0 |
| Obstetrics and Gynecology | 1 | 1 |
| Geriatrics | 1 | 0 |
| Hematology | 0 | 3 |
| Plastic surgery | 0 | 1 |
| Urology | 0 | 1 |
| Gastro-enterology | 0 | 1 |
| Medical diagnosis | ||
| Intoxication | 5 | 0 |
| Neoplasms | 3 | 5 |
| Traumatic wounds | 3 | 0 |
| Neurotrauma/hemorrhage/angiopathy | 3 | 2 |
| Cardiac arrest/infarction/failure | 3 | 4 |
| Auto-immune (encephalitis/SLE/myositis) | 2 | 2 |
| Epilepsy | 1 | 0 |
| Physical decline/electrolyte disorder | 2 | 0 |
| Pneumococcal pneumonia | 1 | 0 |
| COVID-19 | 1 | 7 |
| Kidney transplant | 1 | 0 |
| Acute renal failure | 1 | 0 |
| Hydrocephalus | 0 | 2 |
| Myelodysplasia | 0 | 2 |
| Bilateral lung transplant | 0 | 1 |
| Porphyria | 0 | 1 |
| Miscellaneous | 5 | 5 |
| Psychiatric diagnosis | ||
| Schizophrenia / psychotic disorders | 9 | 3 |
| Delirium | 5 | 20 |
| Depressive disorder | 5 | 2 |
| Disorders due to substance use/intoxication or addictive behaviors | 4 | 0 |
| Bipolar or related disorders | 2 | 0 |
| Neurocognitive disorders (excluding delirium) | 2 | 0 |
| Anxiety or fear-related disorders | 1 | 4 |
| Conversion disorder | 1 | 1 |
| Psychogenic Non-Epileptic Disorder | 1 | 0 |
| Personality Disorder | 1 | 1 |
Table 3
InDiBI Scores for 31 MPU and 31 PCS Patients.
| DEPARTMENT | MPU | PCS |
|---|---|---|
| Perception of Manageability | ||
| Number of manageable patients | 23 | 27 |
| Number of Disruptive Behaviors (max = 14 per patient) | ||
| Total | 112 | 62 |
| Minimum | 1 | 0 |
| Maximum | 8 | 6 |
| Range | 7 | 6 |
| Median | 4 | 2 |
| IQR | 2–5 | 1–3 |
| Number of cases per behavior | ||
| Aggression | 6 | 2 |
| Suicidal behavior* | 9 | 3 |
| Self-harm* | 8 | 1 |
| Claiming behavior | 3 | 5 |
| Uncooperative | 14 | 11 |
| Delusions* | 14 | 3 |
| Hallucinations | 6 | 5 |
| Agitation* | 19 | 11 |
| Disinhibition or loss of decorum | 7 | 2 |
| Shouting and screaming | 9 | 4 |
| Wandering | 4 | 3 |
| Inertia | 3 | 2 |
| Apathy | 7 | 9 |
| Refusal to eat and/or drink | 3 | 1 |
[i] *P ≤ 0.05: on chi-square test.
Table 4
Referral reasons according to the Ad hoc questionnaire.
| N | MEAN | SD | MEDIAN | IQR | P t-test | TIMES “YES” | |
|---|---|---|---|---|---|---|---|
| 1: Staff Competencies: 7 items | |||||||
| MPU | 31 | 3.35 | 1.33 | 3 | 2 | <0.001 | 104 (out of 217) |
| PCS | 31 | 1.74 | 1.29 | 2 | 1 | 54 | |
| 2: Patient Characteristics: 8 items | |||||||
| MPU | 31 | 4.97 | 1.42 | 5 | 2 | 0.007 | 154 (out of 248) |
| PCS | 31 | 4.00 | 1.32 | 4 | 2 | 124 | |
| 3: Psychiatric symptoms and Behavioral problems: 6 items | |||||||
| MPU | 31 | 1.70 | 1.32 | 2 | 1 | 0.45 | 53 (out of 186) |
| PCS | 31 | 1.09 | 1.01 | 1 | 2 | 34 | |
| 4: Medical needs and capabilities: 1 item | |||||||
| MPU | 31 | 0.29 | 0.46 | 0 | 1 | 0.22 | 9 (out of 31) |
| PCS | 31 | 0.16 | 0.37 | 0 | 0 | 5 | |
| 5: Patient context: 1 item | |||||||
| MPU | 31 | 0.35 | 0.49 | 0 | 1 | 0.40 | 11 (out of 31) |
| PCS | 31 | 0.26 | 0.44 | 0 | 1 | 8 | |
Table 5
Number of ‘yes’ answers per item of the Ad hoc questionnaire.
| QUESTION | MPU | PCS | |
|---|---|---|---|
| Question 1–7 : Staff competencies [Caarls’ Cluster 1] | ‘Yes’ | ‘Yes’ | |
| 1 | Preventive, to prevent behavioral and/or psychological problems | 10 | 10 |
| 2 | There is insufficient expertise on the current department* | 24 | 12 |
| 3 | The nursing care load is too high because of the psychiatric problems* | 21 | 8 |
| 4 | Aftercare is needed for the psychiatric problem* | 20 | 12 |
| 5 | There are problems surrounding the patient’s discharge (not being psychiatric aftercare)* | 8 | 1 |
| 6 | There is a shortage of beds on the regular ward | 4 | 2 |
| 7 | The problem is too complicated for treatment elsewhere* | 17 | 9 |
| Question 8–15: Patient characteristics [ Caarls’ Cluster 2] | |||
| 8 | A psychiatric problem is prominent* | 27 | 9 |
| 9 | Further diagnostics are needed to determine the cause of the behavior (psychological or medical) | 9 | 9 |
| 10 | There is a psychiatric history* | 25 | 14 |
| 11 | There is a history of substance abuse | 13 | 6 |
| 12 | A psychiatric or behavioral disorder interferes with the medical treatment | 17 | 20 |
| 13 | Treatment on the regular ward is impeded by the psychiatric or behavioral problem or vice versa* | 22 | 14 |
| 14 | Sufficient recovery is expected within the foreseeable future for transfer to a psychiatric or medical ward, elsewhere or home* | 31 | 25 |
| 15 | The psychiatric or behavioral problem is the result of a medical treatment or medical condition* | 10 | 27 |
| Question 16–21: Psychiatric symptoms and Behavioral problems [Caarls’Cluster 3] | |||
| 16 | There is a personality disorder | 8 | 5 |
| 17 | There is an intoxication or substance abuse issue | 11 | 5 |
| 18 | Delirium is present* | 8 | 16 |
| 19 | The patient has committed a suicide attempt* | 10 | 1 |
| 20 | There is evidence of suicidality* | 10 | 2 |
| 21 | There is aggression towards others | 6 | 5 |
| Question 22: Medical needs and Capabilities [Caarls’ Cluster 4] | |||
| 22 | There is a problematic interaction between patient and the medical staff | 11 | 8 |
| Question 23: Patient Context [Caarls’ Cluster 5] | |||
| 23 | There is a too complicated medical problem in a psychiatric patient | 9 | 5 |
[i] *P ≤ 0.05: on chi-square test.