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Abstract: The role of Constant Observation (COb) in the general hospital is addressed. The difficulties of managing acute psychological disturbance in the general hospital are described. Concerns about confused behavior and suicidal risk appear to be the most common reasons for ordering COb. Organic brain syndrome is the most common diagnosis made in patients receiving COb. Medico-legal, ethical and therapeutic aspects of COb are noted. To our knowledge there is no research evidence that COb significantly decreases the rate of suicide in the general hospital. It appears that the role of COb is enshrined in the general hospital as a result of medico-legal process in addition to its therapeutic role. Further research in this area is needed.
Introduction:
Constant observation (COb) is an intervention in which continuous one-to-one monitoring is used to assure the safety and well-being of an individual patient or others (1). In the general hospital, COb is most commonly recommended for patients who suffer from delirium (1). Concerns about the patient harming himself or others are further reasons for COb being ordered (2-4).
Management of Acute Psychological Disturbance in the General Hospital
Concerns about patient violence toward self or others generates considerable tension in the general hospital environment. The staff often feel a lack of expertise in dealing with these phenomena and the physical surroundings do not lend themselves to containment of acutely disruptive behavior. The comorbidity of physical and psychiatric pathology in the patient creates frustration in the treating staff particularly where overworked nursing resources are further stretched by needing to supervise patients often confused, who are prone to walk off the ward. There may be escalating confrontation between the patient and the staff leading to staff demands for discharge or transfer of the patient to a psychiatric setting. The patient may react negatively to the perceived rejection by general hospital staff creating further escalation of tension between patient and staff. If there is no psychiatric ward located in the general hospital campus, the process of transferring the patient to a psychiatric ward off campus may be a formidable task involving the patient, his/her family and COb staff. According to Israeli law (5), urgent involuntary psychiatric hospitalization in the Israeli general hospital setting is possible. The examining psychiatrist needs...