Audit Tools and Quality Improvement HQIP conference 2013 EMCC, 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 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

Suicide rate per 100,000 * = significant difference p<0.05 Do policies make a difference? *

Pre and post suicide rates ( ) 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

Suicide prevention in Manchester Greater Manchester West Mental Health Foundation Trust NCISH Toolkit GMW local audit

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’

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