Evaluation of a New Recovery-oriented Model of Psychiatric Inpatient Care

NCT ID: NCT06250296

Last Updated: 2024-07-03

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 700 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2024-02-15
• Study Completion Date: 2025-10-31

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.

Conditions

Psychiatric Hospitalization; Coercion; Recovery

Study Design

• Observational Model Type: CASE_CONTROL
• Study Time Perspective: PROSPECTIVE

Study Groups

Intervention group

All patients admitted to the ward implementing the foreseen intervention as to February 2024 (pilot phase)

New model of psychiatric inpatient care

Intervention Type: OTHER

The intervention envisages major structural changes in wards, in particular the reorganization of clinical discussion and decision-making spaces, as well as the medical and nursing referral system, and the inclusion of relatives in care:

• Treatment planning involving the patient, with a focus on his or her needs and resources.
• Care by referral teams, present every day of the week, to ensure continuity and consistency of care.
• As few decisions as possible made without the patient, and transparency in decision-making.
• Emphasis on the subjective meaning of illness, beyond symptoms.
• Greater visibility of care planning for patients, who will benefit from weekly agendas
• Closer collaboration with relatives, through open invitations to all clinical discussions, telephone hotlines and meeting times.
• Openness to the network and community care, by promoting communication and exchanges between all stakeholders, and the development of early warning tools such as the joint crisis plan.

Control group

All patients admitted to the two wards implementing the foreseen intervention after the initial pilot phase

No interventions assigned to this group

Interventions

New model of psychiatric inpatient care

The intervention envisages major structural changes in wards, in particular the reorganization of clinical discussion and decision-making spaces, as well as the medical and nursing referral system, and the inclusion of relatives in care:

• Treatment planning involving the patient, with a focus on his or her needs and resources.
• Care by referral teams, present every day of the week, to ensure continuity and consistency of care.
• As few decisions as possible made without the patient, and transparency in decision-making.
• Emphasis on the subjective meaning of illness, beyond symptoms.
• Greater visibility of care planning for patients, who will benefit from weekly agendas
• Closer collaboration with relatives, through open invitations to all clinical discussions, telephone hotlines and meeting times.
• Openness to the network and community care, by promoting communication and exchanges between all stakeholders, and the development of early warning tools such as the joint crisis plan.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Patients hospitalized in one of the three participating wards

Exclusion Criteria

• Incapacity to give informed consent
• Insufficient knowledge of French

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Fondation Privée des HUG

UNKNOWN

Sponsor Role: collaborator

IF International Foundation

UNKNOWN

Sponsor Role: collaborator

University Hospital, Geneva

OTHER

Sponsor Role: lead

Responsible Party

Alexandre Wullschleger, MD

Principal investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Alexandre Wullschleger, MD

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Geneva

Locations

HUG - Hôpital de Belle-Idée

Thônex, , Switzerland

Site Status: RECRUITING

Countries

Switzerland

Central Contacts

Alexandre Wullschleger, MD

Role: CONTACT

alexandre.wullschleger@hcuge.ch

+41795534904

Facility Contacts

Alexandre Wullschleger, MD

Role: primary

alexandre.wullschleger@hcuge.ch

+41795534904

Other Identifiers

RP-07-06

Identifier Type: -

Identifier Source: org_study_id