audit tools and quality improvement hqip conference 2013 emcc, nottingham
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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
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10
12
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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/
- Follow link to National Confidential Inquiry
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