Psychiatric Quarterly, Vol. 76, No. 1, Spring 2005 (
Patient Safety on Adult Inpatient Services
Ann Marie Sullivan, M.D.
The safe treatment of patients in crisis is a challenge. Acute care psy-
chiatric inpatient services are called upon every day to treat safely and
effectively patients whose behaviors are truly acutely dangerous to self
or others. Surprisingly, there is a paucity of research on best practices
to treat these behaviors in an acute inpatient setting.
The three papers presented here detail a systems approach to patient
safety on the adult inpatient service in a New York City municipal safety
net hospital, and at its Corporate headquarters. At Elmhurst Hospital
Center, where I am the director, the administrative and clinical team
joined together to improve patient safety in the two most critical areas
unique to psychiatry: violence and suicide. The third paper outlines a
Health and Hospitals Corporation system wide initiative to empower
patients and increase their active participation in the management of
The ﬁrst paper describes a patient violence safety project that dra-
matically decreased the use of seclusion and restraints in our large
inpatient service, without increasing injuries, altercations or use of
emergency medication. The key factor here was a change in staff at-
titudes from one of fear and authoritative control of violent behavior, to
utilizing crisis management, prevention, and engagement in partner-
ship with the patient to manage violent behavior. Such a team approach
takes great staff dedication, teamwork among doctors, nurses and the
entire inpatient team in learning and implementing new techniques,
and ongoing intensive support from clinical administration.
The second paper, also from Elmhurst Hospital, tackles the second
most critical issue on inpatient services, the safe and effective treat-
ment of the suicidal patient. Here the clinical and administrative team
2005 Springer Science+Business Media, Inc.