Research Article: High and Intensive Care in Psychiatry: Validating the HIC Monitor as a Tool for Assessing the Quality of Psychiatric Intensive Care Units

Date Published: August 17, 2018

Publisher: Springer US

Author(s): A. L. van Melle, Y. Voskes, H. C. W. de Vet, J. van der Meijs, C. L. Mulder, G. A. M. Widdershoven.


This study aims to validate the HIC monitor as a model-fidelity scale to the High and Intensive Care (HIC) model, a recently developed model for acute psychiatric wards. To assess the psychometric properties of the HIC monitor, 37 audits were held on closed inpatient wards at 20 psychiatric hospitals in the Netherlands. Interrater reliability, construct validity and content validity were examined. Our results suggest that the HIC monitor has good psychometric properties. It can be used as a tool for assessing the implementation of the HIC model on acute psychiatric wards in the Netherlands, and for quality assessment and improvement.

Partial Text

Quality of care in acute psychiatry is a subject of international debate. There are three main issues of concern: (1) prevention of coercion, especially seclusion (Huckshorn 2006; Noorthoorn et al. 2016; Steinert and Lepping 2009; Voskes et al. 2013); (2) improvement of continuity of care, particularly between in- and outpatient care (Bachrach 1981); and (3) fostering collaboration between mental healthcare professionals, patient, and relatives (Malm et al. 2015). In the Netherlands, patients are generally treated by ambulatory care teams, such as Active Community Treatment teams (ACT), Flexible Active Community Treatment teams (FACT), and by Intensive Home Treatment teams. Admissions to a psychiatric ward can be arranged by these teams, by the police or by psychiatric emergency services. Patients can be admitted to either an open ward or a closed ward in a psychiatric hospital. Currently, the number of beds on closed wards is declining and many open wards have already been closed, thereby increasing the pressure on the remaining wards and the need for quality standards. Over recent years, the High and Intensive Care (HIC) model has been developed to improve the quality of mental health care, specifically inpatient care. Representing a new approach to care, and also new material conditions (van Mierlo et al. 2013), the HIC model has been received with growing enthusiasm. By late 2016, 79% of mental healthcare institutions with closed acute admission wards had adopted it and had joined the HIC foundation to start implementing the model.

In conclusion, as a useful tool for assessing the level of implementation of the HIC model on acute psychiatric wards, the HIC monitor can be used for quality assessment and improvement. Our study shows that the HIC monitor has reasonably good psychometric properties. Due to the consensus that was sought during its development and validation, it is an instrument that corresponds closely to daily practice, and may thus benefit the implementation of the HIC model on acute psychiatric wards. As it can be used to study the associations between the components and outcomes of the HIC model (use of coercion, patient satisfaction), it can contribute to the improvement of quality of care for acute psychiatric patients.




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