Clinical trial NCT06250296: Evaluation of a New Recovery-oriented Model of Psychiatric Inpatient Care
Official title: Evaluation of a New Recovery-oriented Model of Care on Psychiatric Inpatient Wards.
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Psychiatric Hospitalization
Coercion
Recovery
Keywords: psychiatric inpatient care
coercion
recovery
patient satisfaction
Lead sponsor: University Hospital, Geneva
Sponsor class: OTHER
Collaborators: name: Fondation Privée des HUG
name: IF International Foundation
First posted: 2024-02-09
Enrollment: 700
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: All patients admitted to the three participating wards during the study period will be considered for participation. All diagnoses will be included, except for dementia. Patients who are not able to give their written consent to participation and/or with insufficient knowledge of French will be excluded from the study.

Brief summary: This project will study the effects of a major reorganization of psychiatric inpatient wards. This reorganization will affect many aspects of day-to-day work, with the aim of improving the individualization of care, the integration of relatives and the participation of the patients in treatment planning. This new organization will initially involve a first pilot ward, before being extended to other wards.

The aim of this project is to understand whether this new organization has positive effects on the use of coercive measures, the average length of stay, the improvement in patients' clinical condition, as well as on patient satisfaction, their perception of coercion, the wards' atmosphere on the unit and patients' personal recovery.

All patients admitted to three wards of the Division of adult psychiatry of the Geneva University Hospital aged 18 and over, with a good knowledge of French and being treated for any type of diagnosis except dementia, are invited to take part in the study. They will be assessed at discharge regarding the selected outcomes. The study will last 18 months: during the first 9 months, the new model will be applied on the pilot ward, and the wo other wards will serve as comparison wards. After 9 months, the model will also be applied to these other two wards.

Detailed description: The project is designed as a prospective, observational study, supporting the planned reorganization of inpatient care with the implementation of a new recovery-oriented model of care. As part of this reorganization, the new model will be first implemented as a pilot on a first acute psychiatric ward. After nine months, it is planned to be generalized to two comparable other acute wards. These two wards will serve within the current project as a comparison group to assess the effects of the new model.

Patients hospitalized on these three wards will be included in the study over a period of 18 months, covering the initial implementation of the model and its subsequent extension to the other two wards.

Three psychiatric wards of the Division of adult Psychiatry (SPA) will participate in the study. These wards are dedicated to general psychiatric admissions following a sectorization plan and operate with an open-door policy, wherein the wards' doors are uninterruptedly open between 7:30 am. and 11 pm. Patients aged 18 to 65 with all types of diagnosis at the exception of primary substance-abuse disorders and dementia, which are mainly treated in other divisions, are treated on these wards.

All patients admitted to these wards during the study period will be considered for participation. All diagnoses will be included, except for dementia. Patients who are not able to give their written consent to participation and/or with insufficient knowledge of French will be excluded from the trial.

Patient fulfilling the inclusion criteria will be contacted before discharge and offered to participate in the study. They will be informed in writing of the purpose of the study and their written consent will be collected.

Data on coercive measures, length of stay as well as socio-demographic characteristics, diagnosis and admission and discharge HoNOS scores will be extracted from the patients' electronic record.

The assessment of patients' satisfaction, perceived coercion, personal recovery, patients' appraisal of the ward atmosphere, and their perception of care as supporting to their recovery will be carried at discharge using digital questionnaires on the REDCAP platform, using tablets. The planned assessment will take about 30 to 45 minutes.

Eligibility criteria: Inclusion Criteria:

* Patients hospitalized in one of the three participating wards

Exclusion Criteria:

* Incapacity to give informed consent
* Insufficient knowledge of French

Primary outcomes:
measure: Coercive measures
timeFrame: For each included participant at discharge from hospital, throughout the study (18 months)
Secondary outcomes:
measure: Length of stay
timeFrame: For each included participant at discharge from hospital, throughout the study (18 months)
measure: Symptom burden
timeFrame: For each included participant at discharge from hospital, throughout the study (18 months)
measure: Length of stay under involuntary status
timeFrame: For each included participant at discharge from hospital, throughout the study (18 months)
measure: Personal recovery
timeFrame: For each included participant at discharge from hospital, throughout the study (18 months)
measure: Subjective coercion 1
timeFrame: For each included participant at discharge from hospital, throughout the study (18 months)
measure: Subjective coercion 2
timeFrame: For each included participant at discharge from hospital, throughout the study (18 months)
measure: Ward atmosphere
timeFrame: For each included participant at discharge from hospital, throughout the study (18 months)
measure: Patients' satisfaction
timeFrame: For each included participant at discharge from hospital, throughout the study (18 months)
measure: Recovery-orientation of services
timeFrame: For each included participant at discharge from hospital, throughout the study (18 months)
Other outcomes:
Locations:
city: Thônex
country: Switzerland
facility: HUG - Hôpital de Belle-Idée
Study officials:
affiliation: University Hospital, Geneva
name: Alexandre Wullschleger, MD
role: PRINCIPAL_INVESTIGATOR
References: