Comparing clinical risk assessments using operationalized criteria.
OBJECTIVE
To compare the clinical risk assessment of patients by psychiatrists working in different mental health service settings (low, medium and high security).


METHODS
Operationalized criteria of clinical factors recognized as indicating risk of harm to others were developed into a simple checklist with explicit item descriptions and definitions (OP-RISK). This was used to compare risk assessments in a prospective cohort of 161 consecutive referrals to a high secure psychiatric hospital.


RESULTS
Agreement on the risk posed by a patient between psychiatrists working outside and inside high secure services using unstructured clinical risk assessment was poor (kappa=-0.006). When OP-RISK was applied to the clinical risk assessments, agreement improved (kappa=0.742).


CONCLUSIONS
Applying operationalized criteria to clinical risk assessment is useful in integrating different mental health service settings. The use of OP-RISK may facilitate the referral process to tertiary care.
Brown
C S H
CS
Department of Mental Health, University of Exeter, Exeter, UK.
Lloyd
K R
KR
D015331:Cohort Studies; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D012920:Social Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data*