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Brief Reports   |    
Does the Redesign of a Psychiatric Inpatient Unit Change the Treatment Process and Outcomes?
Karen A. Urbanoski, Ph.D.; Benoit H. Mulsant, M.D.; Gabriela Novotna, Ph.D.; Sahar Ehtesham, H.B.Sc.; Brian R. Rush, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.004532012
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Dr. Urbanoski, Dr. Mulsant, and Dr. Rush are affiliated with the Centre for Addiction and Mental Health, where Dr. Urbanoski and Dr. Rush are with the Health Systems and Health Equity Research Unit, University of Toronto, T309, 33 Russell St., Toronto, Ontario M5S 2S1, Canada (e-mail: karen_urbanoski@camh.net). Dr. Urbanoski is also with the Dalla Lana School of Public Health, and Dr. Mulsant and Dr. Rush are also with the Department of Psychiatry, University of Toronto. Dr. Novotna is with the Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada. Ms. Ehtesham is with the Department of Endocrinology, Hospital for Sick Children, Toronto.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study investigated whether ward atmosphere mediated the associations between the physical and therapeutic characteristics of an inpatient ward and patient outcomes.

Methods  Individuals (N=290) receiving inpatient care for mood and anxiety disorders before and after an extensive renovation project were surveyed about ward atmosphere, quality of life, and treatment satisfaction. Global functioning at admission and discharge and other clinical characteristics were obtained from patients’ charts.

Results  After the redesign, participants perceived improved ward atmosphere, and the improvement was associated with greater treatment satisfaction and quality of life. Change in global functioning was independent of ward atmosphere.

Conclusions  Efforts to improve the inpatient environment by supporting patient autonomy, peer support, and practical skill development may be expected to meet with improved outcomes, at least for quality of life and satisfaction with treatment. These findings are consistent with patient-centered design as well as with broader perspectives on recovery-oriented services.

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Table 1Effect of unit redesign on outcomes among 290 patientsa
Table Footer Note

a The direct effect of the redesign was determined by controlling for ward atmosphere, and the indirect effect reflected the test of mediation by ward atmosphere. For quality of life and global functioning, the direct and indirect effects are adjusted for the corresponding baseline score; for treatment satisfaction, the direct and indirect effects are adjusted for baseline functioning.

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