Differences in Seclusion Rates Between Admission Wards: Does Patient Compilation Explain?

Comparison of seclusion figures between wards in Dutch psychiatric hospitals showed substantial differences in number and
duration of seclusions. In the opinion of nurses and ward managers, these differences may predominantly be explained by differences
in patient characteristics, as these are expected to have a large impact on these seclusion rates. Nurses assume more admissions
of severely ill patients are related to higher seclusion rates. In order to test this hypothesis, we investigated differences
in patient and background characteristics of 718 secluded patients over 5,097 admissions on 29 different admission wards over
seven Dutch psychiatric hospitals. We performed an extreme group analysis to explore the relationship between patient and
ward characteristics and the wards’ number of seclusion hours per 1,000 admission hours. In a multivariate and a multilevel
analysis, various characteristics turned out to be related to the number of seclusion hours per 1,000 admission hours as well
as to the likelihood of a patient being secluded, confirming the nurses assumptions. The extreme group analysis showed that
seclusion rates depended on both patient and ward characteristics. A multivariate and multilevel analyses revealed that differences
in seclusion hours between wards could partially be explained by ward size next to patient characteristics. However, the largest
deal of the difference between wards in seclusion rates could not be explained by characteristics measured in this study.
We concluded ward policy and adequate staffing may, in particular on smaller wards, be key issues in reduction of seclusion.