A Simple Tool May Help Inexperienced Psychiatrists Better
Predict Violence Risk in Patients. Inexperienced psychiatrists are less likely
than their veteran peers to accurately predict violence by their patients, but
a simple assessment checklist might help bridge that accuracy gap, according to
new research from the University of Michigan.
Led by psychiatrist Alan Teo, M.D., a Robert Wood Johnson
Foundation Clinical Scholar of the University of Michigan, researchers examined
how accurate psychiatrists were at predicting assaults by acutely ill patients
admitted to psychiatric units.
Their results found that inexperienced psychiatric
resident doctors did no better than a coin flip, whereas veteran psychiatrists
were 70 percent accurate in predicting risk of violence.
However, when a brief risk assessment tool was applied to
the cases that the junior doctors evaluated, their level of accuracy jumped to
67 percent, or nearly as good as the more experienced psychiatrists. Results of
the research were published online Sept. 1 in the journal Psychiatric Services.
"The tool we used, called the HCR-20-C, is
remarkably brief and straightforward. Like a checklist a pilot might use before
takeoff, it has just five items that any trained mental health professional can
assess," Teo says.
In light of recent violent events, such as the movie
theater shooting in Aurora, Colo,, earlier this summer, Teo says predicting
violence risk in psychiatric patients is an increasingly important topic.
"Given public concern about this issue, I think teaching
our budding psychiatrists and others how to use a practical tool like this, and
encouraging its use in high-risk settings is a no-brainer," he says.
In the study, researchers were able to assess doctors'
accuracy by comparing patients who had assaulted hospital staff members with
similar patients who had not been violent.
Because all patients received a threat assessment when
admitted to the psychiatric unit, the researchers were able to compare a
patient's predicted violence risk with whether they actually had a documented
assault while in the hospital.
Incidents of physical aggression typically included
punching, slapping, or throwing objects, as well as yelling, directed at staff
members of the hospital. The patients studied had severe illnesses, often
schizophrenia, and had been involuntarily admitted to the hospital.
Teo says this study is the first to compare the
predictive success of violence assessment between experienced and inexperienced
psychiatrists. The results, he says, highlight the importance of emphasizing
violence risk assessment in clinical training programs.
"If trainees are indeed less able than trained and
experienced clinicians to accurately perform risk assessments for violence,
it's important to figure out a way to improve their accuracy," he says.
"Our study shows that evidence-based structured tools might have the
potential to augment training and improve risk assessment."
Image Source: http://www.sxc.hu/photo/1399727
Image Source: http://www.sxc.hu/photo/1399727
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