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de Smet L, Carpels A, Creten L, De Pauw L, Van Eldere L, Desplenter F, De Hert M. Prevalence and characteristics of registered falls in a Belgian University Psychiatric Hospital. Front Public Health 2022; 10:1020975. [PMID: 36388388 PMCID: PMC9651969 DOI: 10.3389/fpubh.2022.1020975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/13/2022] [Indexed: 01/28/2023] Open
Abstract
Objectives Falls in elderly patients treated in general hospitals have already been the focus of several studies. Research within psychiatric settings, however, remains limited, despite the fact that this population has a number of characteristics that could increase the fall risk. The aim of this retrospective study was to estimate the prevalence of falling in patients with a psychiatric hospital setting. Methods A retrospective descriptive chart review of falls registered in the period July 1, 2013 until June 30, 2019 in a Belgian University Psychiatric Hospital was conducted. Data were collected from the "patient related incident report and management system" (PiMS) of the hospital. All registered falls of all hospitalized patients were included in the study. Results During the 6-year study period an incidence of 4.4 falls per 1,000 patient days was found. Only 0.5% of the falls resulted in severe injury and none of these falls were fatal. Eighty percent of falls involved a patient over the age of 65. Only 25.0% of the elderly patients suffered physical consequences, while injuries were present in 31.4% of adults and 68.2% of young patients. The two most common causes of a fall were the health status (63.3%) and the behavior (55.1%) of the patient. Conclusion The estimated prevalence of falls in our study was generally in line with the rates found in literature on falls in psychiatric settings. Falls in psychiatric settings occur both in younger and older patients, suggesting that all age categories deserve sufficient attention in fall prevention policies. However, more research is necessary to improve fall prevention policies.
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Affiliation(s)
- Lynn de Smet
- University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Arnout Carpels
- University Psychiatric Center, KU Leuven, Leuven, Belgium
- Public Psychiatric Care Center Rekem, Rekem, Belgium
| | - Lotte Creten
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Louise De Pauw
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Franciska Desplenter
- University Psychiatric Center, KU Leuven, Leuven, Belgium
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marc De Hert
- University Psychiatric Center, KU Leuven, Leuven, Belgium
- Center for Clinical Psychiatry, Department of Biomedical Sciences, KU Leuven, Leuven, Belgium
- Antwerp Health Law and Ethics Chair, Universiteit Antwerpen, Antwerp, Belgium
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Abstract
OBJECTIVES The past 20 years have seen the emergence of a national movement to improve hospital-based healthcare safety in the United States. However, much of the foundational work and subsequent research have neglected inpatient psychiatry. The aim of this article was to advance a comprehensive approach for conceptualizing patient safety in inpatient psychiatry as framed by an application of the Institute of Medicine patient safety framework. METHODS This article develops a framework for characterizing patient safety in hospital-based mental health care. We discuss some of the conceptual and methodological issues related to defining what constitutes a patient safety event in inpatient psychiatry and then enumerate a comprehensive set of definitions of the types of safety events that occur in this setting. RESULTS Patient safety events in inpatient psychiatry are broadly categorized as adverse events and medical errors. Adverse events are composed of adverse drug events and nondrug adverse events, including self-harm or injury to self, assault, sexual contact, patient falls, and other injuries. Medical errors include medication errors and nonmedication errors, such as elopement and contraband. We have developed clear definitions that would be appropriate for use in epidemiological studies of inpatient mental health treatment. CONCLUSIONS Psychiatry has not been an integral part of the national safety movement. As a first step toward breaching this chasm, we have considered how psychiatric events fit into the safety framework adopted across much of medicine. Patient safety should become a key part of inpatient psychiatry's mission and pursued rigorously as the subject of research and intervention efforts.
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Affiliation(s)
- Steven C. Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA
| | - Richard C. Hermann
- Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Tufts Medical Center, Boston
| | - Sara Wiesel Cullen
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA
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Association between Falls and Balance among Inpatients with Schizophrenia: A Preliminary Prospective Cohort Study. Psychiatr Q 2019; 90:111-116. [PMID: 30328019 DOI: 10.1007/s11126-018-9609-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Falls are adverse events affecting psychiatric inpatients that can lead to external injuries, fractures, and death. However, none have attempted to examine fall-related factors, particularly focused on balance, specifically among inpatients with schizophrenia. The present preliminary study aimed to assess the association between falls and balance in patients with schizophrenia. The authors performed baseline assessments of background factors, postural sway, and maximum step length in 120 patients with schizophrenia hospitalized in the psychiatric ward. A prospective 3-month follow-up was conducted, and participants were divided into a fall or non-fall group according to their history of falls during the follow-up. Variance among individual variables was compared between the fall group and non-fall group using the t-test, Mann-Whitney U test, and chi-square test. A total of 16 participants experienced falls in the 3-month follow-up period (13.3%). Comparative factor analysis revealed significant differences between the fall and non-fall groups in terms of the presence or absence of falls within 3 months before follow-up (p = 0.002) and Romberg quotients for sway length (p = 0.02). These findings suggest that fall history could be considered a predictor of future falls, which could help with fall prevention, and that assessment of visual contribution to postural control using the Romberg quotient could play an important role in fall prevention.
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Vermeulen JM, Doedens P, Cullen SW, van Tricht MJ, Hermann R, Frankel M, de Haan L, Marcus SC. Predictors of Adverse Events and Medical Errors Among Adult Inpatients of Psychiatric Units of Acute Care General Hospitals. Psychiatr Serv 2018; 69:1087-1094. [PMID: 30071794 PMCID: PMC6697121 DOI: 10.1176/appi.ps.201800110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to identify factors associated with the occurrence of adverse events (AEs) or medical errors (MEs) during inpatient psychiatric hospitalizations. METHODS A full-probability random sample of 4,371 charts from 14 inpatient psychiatric units at acute care general hospitals in Pennsylvania were reviewed in a two-stage process that comprised screening and flagging by nurses followed by review by psychiatrists. AE and ME rates were calculated overall and then stratified by patient and hospital factors. Unadjusted and adjusted logistic regression models examined predictors of AEs and MEs. RESULTS An AE was identified in 14.5% of hospitalizations (95% confidence interval [CI]=11.7-17.9), and an ME was identified in 9.0% (CI=7.5-11.0). In adjusted analyses, patients with a longer length of stay and older patients had higher odds of experiencing an AE or an ME. Patients ages 31-42 (compared with ages 18-30), with commercial insurance (compared with Medicare or Medicaid or uninsured), or treated at high-volume hospitals (compared with low, medium, or very high) had lower odds of an AE. Patients age 54 or older (compared with ages 18-30), admitted during the weekend, admitted to rural hospitals (compared with urban), or treated at very-high-volume hospitals (compared with high) were more likely to experience an ME. CONCLUSIONS This study provides insight into factors that put patients and hospitals at increased risk of patient safety events. This information can be used to tailor improvement strategies that enhance the safety of patients treated on general hospital psychiatric units.
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Affiliation(s)
- Jentien M Vermeulen
- Dr. Vermeulen, Mr. Doedens, Dr. van Tricht, and Dr. de Haan are with the Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands. Dr. Cullen and Dr. Marcus are with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dr. Hermann is with the Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Tufts Medical Center, Boston. Dr. Frankel is with the Zicklin School of Business, Baruch College, City University of New York, New York
| | - Paul Doedens
- Dr. Vermeulen, Mr. Doedens, Dr. van Tricht, and Dr. de Haan are with the Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands. Dr. Cullen and Dr. Marcus are with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dr. Hermann is with the Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Tufts Medical Center, Boston. Dr. Frankel is with the Zicklin School of Business, Baruch College, City University of New York, New York
| | - Sara W Cullen
- Dr. Vermeulen, Mr. Doedens, Dr. van Tricht, and Dr. de Haan are with the Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands. Dr. Cullen and Dr. Marcus are with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dr. Hermann is with the Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Tufts Medical Center, Boston. Dr. Frankel is with the Zicklin School of Business, Baruch College, City University of New York, New York
| | - Mirjam J van Tricht
- Dr. Vermeulen, Mr. Doedens, Dr. van Tricht, and Dr. de Haan are with the Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands. Dr. Cullen and Dr. Marcus are with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dr. Hermann is with the Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Tufts Medical Center, Boston. Dr. Frankel is with the Zicklin School of Business, Baruch College, City University of New York, New York
| | - Richard Hermann
- Dr. Vermeulen, Mr. Doedens, Dr. van Tricht, and Dr. de Haan are with the Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands. Dr. Cullen and Dr. Marcus are with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dr. Hermann is with the Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Tufts Medical Center, Boston. Dr. Frankel is with the Zicklin School of Business, Baruch College, City University of New York, New York
| | - Martin Frankel
- Dr. Vermeulen, Mr. Doedens, Dr. van Tricht, and Dr. de Haan are with the Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands. Dr. Cullen and Dr. Marcus are with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dr. Hermann is with the Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Tufts Medical Center, Boston. Dr. Frankel is with the Zicklin School of Business, Baruch College, City University of New York, New York
| | - Lieuwe de Haan
- Dr. Vermeulen, Mr. Doedens, Dr. van Tricht, and Dr. de Haan are with the Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands. Dr. Cullen and Dr. Marcus are with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dr. Hermann is with the Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Tufts Medical Center, Boston. Dr. Frankel is with the Zicklin School of Business, Baruch College, City University of New York, New York
| | - Steven C Marcus
- Dr. Vermeulen, Mr. Doedens, Dr. van Tricht, and Dr. de Haan are with the Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands. Dr. Cullen and Dr. Marcus are with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dr. Hermann is with the Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Tufts Medical Center, Boston. Dr. Frankel is with the Zicklin School of Business, Baruch College, City University of New York, New York
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Rao WW, Zong QQ, Lok GKI, Wang SB, An FR, Ungvari GS, Ng CH, Xiang YT. Prevalence of falls in adult and older adult psychiatric patients in China: A systematic review and comprehensive meta-analysis of observational studies. Psychiatry Res 2018; 266:18-25. [PMID: 29800776 DOI: 10.1016/j.psychres.2018.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/25/2018] [Accepted: 05/05/2018] [Indexed: 11/24/2022]
Abstract
Falls have significant health consequences and are common in psychiatric patients. Findings on the prevalence of falls in Chinese adult and older adult psychiatric inpatients have been inconsistent. This meta-analysis examined the pooled prevalence of falls in adult and older adult psychiatric inpatients in China. Both English (PubMed, EMBASE, Web of Science, PsycINFO, Cochrane Library) and Chinese (China National Knowledge Interne, WanFang Data and SinoMed) databases were searched independently by three reviewers. The pooled prevalence of falls and its 95% confidence intervals (CIs) using the random effects model were calculated. A total of 39 studies covering 204,234 inpatients were analyzed. The pooled prevalence of falls in adult and older adult (≥60 years) patients was 3% (95% CI: 1.8%-5%) and 7.3% (95%CI: 5.0%-10.6%), respectively. Subgroup analyses revealed that the prevalence of falls was significantly associated with the psychiatric diagnostic criteria and study sample size. This meta-analysis found that the prevalence of falls among adult and older adult psychiatric patients in China was significantly high, although less than that was reported from Western psychiatric inpatient settings.
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Affiliation(s)
- Wen-Wang Rao
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Qian-Qian Zong
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Grace K I Lok
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China; Kiang Wu Nursing College of Macau, Macau SAR, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | - Gabor S Ungvari
- The University of Notre Dame Australia / Graylands Hospital, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Abstract
OBJECTIVE Although reducing adverse events and medical errors has become a central focus of the U.S. health care system over the past two decades both within and outside the Veterans Health Administration (VHA) hospital systems, patients treated in psychiatric units of acute care general hospitals have been excluded from major research in this field. METHODS The study included a random sample of 40 psychiatric units from medical centers in the national VHA system. Standardized abstraction tools were used to assess the electronic health records from 8,005 hospitalizations. Medical record administrators screened the records for the presence of ten specific types of patient safety events, which, when present, were evaluated by physician reviewers to assess whether the event was the result of an error, whether it caused harm, and whether it was preventable. RESULTS Approximately one in five patients experienced a patient safety event. The most frequently occurring events were medication errors (which include delayed and missed doses) (17.2%), followed by adverse drug events (4.1%), falls (2.8%), and assault (1.0%). Most patient safety events (94.9%) resulted in little harm or no harm, and more than half (56.6%) of the events were deemed preventable. CONCLUSIONS Although patient safety events in VHA psychiatric inpatient units were relatively common, a great majority of these events resulted in little or no patient harm. Nevertheless, many were preventable, and the study provides data with which to target future initiatives that may improve the safety of this vulnerable patient population.
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Abstract
Fall rates from 3.2 to 17.1 falls per 1,000 hospital days in geriatric psychiatry facilities have been reported to date. Up to 5% of the falls result in severe injuries, but data concerning medical consequences are scare. This brief report presents a retrospective analysis of one year fall protocols from a geriatric psychiatry department focusing on consequences of falls. Fall-induced injuries were rated in four categories: no injuries, mild injuries (contusions, hematomas, abrasions), moderate injuries (lacerations, dislocations), and severe injuries (fractures, cerebral hemorrhages). In total, 510 falls were registered during the study period, indicating a fall rate of 17.7 falls per 1,000 hospital days. Overall, 375 falls (73.5%) resulted in no injuries, 67 (13.1%) resulted in mild injuries, 59 (11.6%) resulted in moderate injuries, and only 9 (1.8%) falls led to severe injuries (fractures and cerebral hemorrhages). These results indicate a quite high fall rate in our sample of hospitalized geriatric psychiatry patients with only a relatively small number of severe injuries resulting from the falls. These results raise the question about the use of physical restraints and the use of bedrails in geriatric patients to prevent falls as the medical implications of falls may be less problematic than previously thought.
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True G, Frasso R, Cullen SW, Hermann RC, Marcus SC. Adverse events in veterans affairs inpatient psychiatric units: Staff perspectives on contributing and protective factors. Gen Hosp Psychiatry 2017; 48:65-71. [PMID: 28843113 PMCID: PMC5605148 DOI: 10.1016/j.genhosppsych.2017.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/13/2017] [Accepted: 07/15/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to identify risk factors and protective factors in hospital-based mental health settings in the Veterans Health Administration (VHA), with the goal of informing interventions to improve care of persons with serious mental illness. METHODS Twenty key informants from a stratified sample of 7 VHA inpatient psychiatric units were interviewed to gain their insights on causes of patient safety events and the factors that constrain or facilitate patient safety efforts. RESULTS Respondents identified threats to patient safety at the system-, provider-, and patient-levels. Protective factors that, when in place, made patient safety events less likely to occur included: promoting a culture of safety; advocating for patient-centeredness; and engaging administrators and organizational leadership to champion these changes. CONCLUSIONS Findings highlight the impact of systems-level policies and procedures on safety in inpatient mental health care. Engaging all stakeholders, including patients, in patient safety efforts and establishing a culture of safety will help improve the quality of inpatient psychiatric care. Successful implementation of changes require the knowledge of local experts most closely involved in patient care, as well as support and buy-in from organizational leadership.
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Affiliation(s)
- Gala True
- Department of Veterans Affairs, South Central Mental Illness Research Education and Clinical Center, New Orleans, LA, United States.
| | - Rosemary Frasso
- School of Population Health, Jefferson University, Philadelphia, PA, United States
| | - Sara W Cullen
- School of Social Practice & Policy, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Steven C Marcus
- School of Social Practice & Policy, University of Pennsylvania, Philadelphia, PA, United States
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Abstract
Patient falls in psychiatric units may have an impact on patient outcomes. Fall risk assessment among psychiatric patients is an important issue. Gait/balance problems and history of falling are important considerations in assessing psychiatric patients for fall risk.
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Affiliation(s)
- D J Irvin
- St. John's College Department of Nursing, Springfiled, IL 62702, USA
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Affiliation(s)
- K L Ash
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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Cutillo-Schmitter TA, Rovner B, Shmuely Y, Bawduniak I. Formulating treatment partnerships with patients and their families. A case study. J Gerontol Nurs 1996; 22:23-36. [PMID: 9036153 DOI: 10.3928/0098-9134-19960601-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
1. A care environment, per se, can foster patient recovery and confidence that things will work out as well as can be expected when staff practices and explicit processes are patient-centered and adapted to developmental and individual needs. 2. Separating more cognitively impaired from higher functioning patients and developing more specialized nursing teams affords a healing and restorative care environment, individualized care routines and specialty groups along with finely-tuned patient/family education. 3. Organized staff education and mentoring programs combined with master scheduling enhances the continuity of patient-centered practices and risk management protocols.
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Vaughn K, Young BC, Rice F, Stoner MH. A RETROSPECTIVE STUDY OF PATIENT FALLS IN A PSYCHIATRIC HOSPITAL. J Psychosoc Nurs Ment Health Serv 1993; 31:37-42. [PMID: 8229912 DOI: 10.3928/0279-3695-19930901-10] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. While falls on medical-surgical units are the focus of extensive research, falls on inpatient psychiatric units are an understudied critical event. 2. The purposes of this study were to identify the variables associated with psychiatric patient falls and to use that information to assess risk and, therefore, prevent falls in this population. 3. The psychiatric patient at risk for falling is described as a woman with a prior history of falls; less than 65 years of age; experiencing anxiety and agitation; and receiving a sedative, a tranquilizer, and a laxative. Additionally, this patient is more likely to fall in a community area.
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Affiliation(s)
- K Vaughn
- Colorado Psychiatric Hospital, Denver 80262
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