Setting

This audit would be relevant to in-patient facilities in all specialties of psychiatry.

Background

A patient's move from an in-patient facility to the community has been identified as the period of maximum suicide risk (National Confidential Inquiry into Suicides and Homicides, 2006). A report by the National Confidential Inquiry into Suicides and Homicides suggested several measures to manage this transition safely. One of these is to offer early follow-up. This is also a key performance indicator and national priority for mental health trusts (Department of Health, 2008).

Standards

Standards were obtained from National Confidential Inquiry into Suicides and Homicides (2006) and local trust ‘7-day follow-up monitoring rules’. The definition of 7-day follow-up is the number of people within adult mental health services under the care programme approach receiving follow-up (by phone or face-to-face) within seven days of discharge from hospital.

The standards applying to the follow-up are:

ᐅ face-to-face contact with the patient

ᐅ telephone contact with the patient where explicitly recorded as acceptable

ᐅ verbal contact with a carer where explicitly recorded as acceptable

ᐅ verbal contact with another care professional where responsibility for followup has been explicitly passed on to another mental healthcare organisation.

For internal monitoring purposes, the 7-day follow-up period is counted from:

ᐅ the start of any leave period from hospital

ᐅ the discharge date from hospital where there is no immediately preceding leave period.

For monitoring purposes, leave periods resulting in return to hospital within 7 days were excluded. Contacts on the same day as discharge were counted as 7-day follow-up provided they began after the recorded discharge or leave start time and took place in a domiciliary location. For mental health trusts to retain their ‘green status’ on this performance indicator, all patients should have received follow-up within 7 days of discharge from hospital.

Method

Data collection

This audit can be performed retrospectively or prospectively. A list of all discharges from the hospital over a specified time was obtained from the medical records department. For a prospective design, an arrangement could be made with medical records to notify the auditor of discharges from hospital on a daily basis.