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EBD Journal Club: An Assessment of Levels of Safety in Psychiatric Units

When: May 25, 2017
Time: 11:00am Pacific
Price: FREE

An Assessment of Levels of Safety in Psychiatric Units, Health Environments Research & Design Journal 2017, Vol. 10(2) 66-80



Objective: This article aims to understand the incident patterns in relation to different types of spaces within a psychiatric unit, which are discussed using the five levels of safety framework.

Background: Implementing measures to improve patient safety is essential particularly in a psychiatric hospital, where limited research has been conducted on inpatient safety. Therefore, this article aims to understand the incident patterns from the lens of the five levels of safety framework, which categorizes spaces according to the level of patient supervision in psychiatric facilities, as follows: service areas, corridors, dayrooms, patient rooms and bathrooms, seclusions and admissions.

Methods: In an 81-bed psychiatric hospital, this mixed-method study drew 7 years of incident reports and caregivers’ perceptions gathered through focus groups. Incident reports on physical safety were analyzed based on the five levels of safety framework (N ¼ 1,316). Focus groups (n ¼ 9) explored the caregivers’ viewpoints on patient safety and five categories of spaces.

Results: Overall findings support the five levels of safety pattern, confirming that most incidents occurred in patient rooms and bathrooms; moreover, relatively fewer incidents happened in dayrooms and corridors. Elopements are higher in hallways and dayrooms. Suicide is most common in patient rooms and bathrooms, and violence is more frequent in dayrooms. Focus groups results yielded insightful recommendations


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Presenting Faculty


Sara Bayramzadeh, PhD, MArch, Research Assistant Professor in the Architecture + Health,
Clemson University

Sara Bayramzadeh research interests include the impact of healthcare facilities design on user experience, patient safety in psychiatric units, health communication, and operational efficiencies. In her role, she contributes to several research projects at the Center for Health Facilities Design and Testing (CHFDT), including a project on the safety and efficiency of operating rooms. She obtained her doctorate in the interdisciplinary program of Design, Construction and Planning from the University of Florida. Her award-winning dissertation explored the role of the interior environment in the physical and psychological safety of psychiatric patients who are one of the most vulnerable patient populations.



Alan J. Card, PhD, MPH

As a Research Associate with The Center for Health Design, Dr. Card has been invaluable in several special projects including the development of the CHD online Safety Risk Assessment. He holds a PhD from the University of Cambridge, and an MPH from the University of South Florida, as well as professional certifications in public health (CPH), healthcare quality (CPHQ), and healthcare risk management (CPHRM).  Dr. Card’s interests include the conceptual frameworks, tools, and techniques by which health service organizations improve patient safety, healthcare quality, patient/user experience, and disaster preparedness. He is the editor of the Journal of Healthcare Risk Management.