Table 41 'Assessment of Suicidal Risk in Schizophrenic Patients'

PSI 41: Assessment of Suicidal Risk in Schizophrenic Patients
Review of a PSI from the Danish National Indicator Project (NIP) (56-58)
Dimension Description
Description of Specific
Aspects of Patient Safety
Schizophrenic patients have a known higher risk of suicidal behaviour
especially in the time right after discharge from hospital. Thus
assessment of suicidal risk at discharge is an adequate measure of
patient safety.
Aim of the PSI This indicator is intended to survey assessment of suicidal risk in
schizophrenic patients discharged from the hospital.
Level of Determination of
Patient Safety
Safety is assessed at the aggregated patient level.
Source(s) Originally a PSI of NIP in Denmark. This PSI is part of an indicator set
of nine indicators for surveillance of the quality of care provide for all
Danish inpatients with schizophrenia (58).
Extent of Clinically
Testing
Over mortality in schizophrenic has been found, this over mortality is
mainly due to suicide (59;60).
Mortality and causes of death was investigated in a total Danish
national sample of 9156 schizophrenic patients admitted for the first
time. Suicide accounted for 50% of deaths in men and 35% of deaths in
women. Suicide risk during the first year of follow-up increased by
56%, with a 50% reduction on psychiatric in-patient facilities (60).
This process PSI of NIP is bases on extensive literature studies and
described in detail (61) in agreement with the National Danish
Guidelines for Schizophrenia (62).
The Danish National Indicator Project aims at documenting and
improving the quality of care, the project was established in 2000 as a
nationwide mandatory multidisciplinary quality improvement project.
From 2000 to 2002, disease-specific clinical indicators and standards
were developed for six diseases: stroke, hip fracture, schizophrenia,
acute gastrointestinal surgery, heart failure, and lung cancer).
Indicators and standards have been implemented in all clinical units
and departments in Denmark treating patients with the six diseases.
Results feedback is monthly, and yearly regional and national audit
processes are organised to explain the results and to prepare
implementation of improvements. All results are published in order to
inform the public, and to give patients and relatives the opportunity to
make informed choices (57).
The NIP expert panel concluded that this PSI generally performs well.
Evidence of Clinically use
of Standards
For at least 90% of all patients discharged from hospital assessment of
suicidal risk is documented in the patients record.
PSI category Diagnose Specific as well as other Specific PSIs.
SImPatIE WP4 ¨C Catalogue of Patients Safety Indicators
104
Data definitions Patients with a primary or secondary diagnosis of schizophrenia (Any
ICD-10 F.20 diagnosis) discharged form hospital.
Numerator Description Assessed and documented suicidal risk within the last week prior to
discharge. Assessment should include an evaluation of depressive
symptoms and the risk of suicide.
Denominator Description Patients discharges from hospital with an ICD-10 diagnosis of any F.20
diagnose (F20.0-F20.99)
Data Source Patient records.
Identifying the
institutional context
The impact of suicides in schizophrenic patients makes this PSI
important in quality improvement policies.
Care Setting The PSI applies for quality health care.
Professionals Responsible
for Health Care
Doctors/Nurses.
Lowest Level of Health
Care Delivery Addressed
Individual clinical department.
Allowance for Patient
Factors
No risk adjustment described.
Stratification by
Vulnerable Populations
Stratification according to :
− Age: 1) Patients ¡Ý 18 years and 2) patients < 18 years
− Psychopathological status: 1) the patient has been diagnosed
within the last 12 month (incident) or 2) the patient was diagnosed
more than 12 month ago (prevalent)
Standard of Comparison No specific time standards given, but yearly comparison has shown to
be good.
Scoring NIP has software for scoring the PSI. Cumulated scores are subjected
to auditing.
On the basis of the first experience with NIP, a number of requirements
has been specified for a forthcoming second generation of clinical
database system has been described. The requirements regard:
coordination, rational management and experience-based development
of IT systems for the clinical databases and integration with present
and forthcoming systems including electronic patient record systems
(63).