Audit Tools and Quality Improvement

HQIP conference 2013EMCC, Nottingham

National Confidential Inquiry into Suicide and Homicide by People with

Mental Illness (NCISH):

Using audit tools for improving quality of mental health services

How can toolkits improve quality of health services?

1. How can research/audit findings help? (NK)

2. The NCISH toolkit and other quality improvement tools (KW)

What is the process of data collection?

Obtain national data

Determine contact with MH services via NHS Trust/board contact

No contact with services <12 months

Contact with services<12 months

Questionnaire sent to clinical teams

How do we collect the data?

England 2000-2010

• General population suicide deaths 49,532

• Suicide rate: 10.1 per 100,000 per year

• Number of patient suicide: (i.e. Inquiry cases): 13,390 (27%)

• 1,200 deaths per year

What is the scale of our database?

• High levels of social isolation, self-harm

and substance misuse

• 1,577 (12%) in-patients

• 2,554 (19%) died within 3 months of discharge

What are some of the key characteristics of our suicides?

What is happening to suicide rates? (Kapur et al. 2012, Psychological Medicine)

What’s happened to the number of deaths in key in-patient groups?

What is happening to rates of suicide in different patient groups? (Kapur et al. 2012, Psychological Medicine)

What works? (While et al., Lancet, 2012)

National policies and recommendations

Safety First (2001): 12 steps to a safer service

•Removal of ligature points

•Assertive outreach

•24-hour crisis team

•7-day follow-up

•Non-compliance

•Dual diagnosis

•Criminal justice information sharing

•Multi-disciplinary review

•Training in suicide risk management

0

2

4

6

8

10

12

14

16

2003 2004 2005 2006

0-6 recommendations 7-9 recommendations

**

* = significant difference p<0.05

Do policies make a difference?

*

Pre and post suicide rates (1997-2006) for implementing services

Data collection, toolkits and service change

NCISH e-questionnaire

NCISH e-questionnaire: consultant page

NCISH e-questionnaire: view

What is the impact on service improvement?

• Data collection tools– reflecting on practice– summary of patient data for consultant

NCISH toolkit

NCISH toolkit

NCISH toolkit

Suicide prevention in ManchesterGreater Greater Manchester Manchester West Mental West Mental Health Health Foundation Foundation TrustTrust

NCISH ToolkitNCISH Toolkit

GMW local GMW local auditaudit

What is the impact on service improvement?

• Data collection tools – – reflecting on practice– summary of patient data for consultant

• Toolkit – individual audit of practice– local organisational audit– evidence based health services

What is the impact on service improvement?

• Data collection tools – – reflecting on practice– summary of patient data for consultant

• Toolkit – individual audit of practice– local organisational audit– evidence based health services– Themed reports

• case studies for services to review• summary of key learning points and ‘how to’

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness

Website:

http://www.bbmh.manchester.ac.uk/cmhr/research/

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