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

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