The Medical Psychiatric Unit (MPU) of the Erasmus MC: a randomized study of effectiveness and costs

Many hospitalized patients have psychiatric comorbidity or behavioral problems.
Behavioral problems can hinder somatic treatment and are a burdenfor
caregivers, staff and other patients. These behavioral problems can be called
'disruptive behavior'. Medical Psychiatric Units (MPUs) are departments that
treat patients with combined severe somatic and psychiatric suffering.
Important goals of MPUs are 1) improving quality and safety of care and 2)
effective care. Research into the effectiveness and cost-effectiveness of MPUs
is scarce, often observational in nature and concerns the quantity and quality
of the care process. Research into the outcomes of care is also scarce. In
particular, there is no research into one of the primary goals of an MPU,
namely a decrease of 'disruptive behavior'. It is therefore still an open
question whether disruptive behavior can indeed be treated more effectively in
an MPU.

The MPU at Erasmus MC focuses on the short-term treatment of disruptive
behavior in patients who have been hospitalized because of a serious physical
illness. In a randomized study, this MPU will be compared with care as usual
(CAU): a 'consultative psychiatric team' either in consultation or as
co-therapist in a medical ward. This CAU is the current form of treatment for
these patients at Erasmus MC. The hypothesis is that 'disruptive behavior' at
the MPU is dealt with more effectively and that therefore the disruptive
behavior in the MPU condition will decrease earlier and / or more than with
CAU.

The primary goal is to investigate whether treatment on the MPU leads to a
reduction of 'disruptive behavior' compared to CAU. Secondary goals are: to
investigate whether treatment at the MPU influences the costs of care for
patients, quality of life, experience and safety of the care provided, as
preceived by patients and their environment, the burden for caregivers, the
quantity and quality of the interventions used by practitioners regarding the
behavioral problems and the effects on the physical and psychological health of
the patients, disruptive behavior as perceived by nursing and medical staff.

Phased, randomized clinical trial. The randomization is adjusted to the demand:
only when a waiting list is created, patients will be randomized. This prevents
the frustration that patients are rejected for the MPU while there are beds
available.

The study design is a randomized clinical trial, where treatment in the MPU is
compared with CAU.

Risks

Moving patients to the MPU could cause an increase in psychiatric or behavioral
discomfort because the patients are moved, and because the environment is less
'normal'. That is conceivable, but also unlikely: The MPU is designed to manage
behavioral and psychiatric disruptions. The expectation is therefore that this
risk will be minimal and that not only the psychiatric or behavioral symptoms
will decrease compared to CAU.

A second risk is that patients do not receive the optimal somatic treatment
because they are no longer in the somatic ward in question. That is also
conceivable, but unlikely: at the MPU, the internist is the main physician,
regardless of the specialist treatment that the patient undergoes. The
referring specialist remains in co-treatment and is therefore always involved.
In addition, the MPU is designed to provide complex somatic care.

Benefits

It is expected that patients, caregivers and employees will experience greater
satisfaction with treatment of patients in the MPU, because this unit is better
equipped to handle disruptive behavior. Therefore, patients will probably feel
more 'understood' and ,as a result, can be treated better.