Patterns of critical incidents and their effect on outcome in an adolescent inpatient service

Objectives: To identify patterns in critical incidents at an inpatient adol escent unit, to determine differences among patients who engage in critical incidents and those who do not, and to ascertain if there is an associatio n between involvement in incidents and outcome of treatment. Method: Retrospective review of all critical incidents reported at an adole scent unit over 30 months. Results: Of 243 adolescents consecutively admitted, 100 (41%) were involved in critical incidents. Aggressive acts were more common in male adolescent s, among patients with conduct or oppositional disorder and/or in those wit h specific learning disorders, and occurred throughout the day. Self-destru ctive events were more common in female adolescents and among patients with borderline personality disorder, and took place mainly in the evening. Ado lescents involved in critical incidents tended to have longer admissions an d had a worse outcome, irrespective of other factors. Conclusions: Critical incidents are common among hospitalized adolescents a nd result in a poorer outcome. Increased structure during the evenings, pro blem-solving and social skills programmes for patients, and specific traini ng for staff regarding management and minimization of critical incidents sh ould be provided.