Developing and pilot testing a psychiatry-specific adverse event medical record screening tool

Background: Despite significant advances in assessing patient safety in general medicine and surgery, the incidence and nature of errors and adverse events in inpatient psychiatry remains largely unknown as research has mostly excluded individuals being treated for psychiatric disorders.

Methods: The current study develops a conceptual model of patient safety events in inpatient psychiatry, describes a newly developed tool, the Psychiatric Review Form, to examine patient safety events in inpatient psychiatry, and presents data from a preliminary medical record review study using the Psychiatric Review Form to review more than 1,500 charts (12 months of inpatient psychiatric discharge data) in three urban hospitals.

Results: The conceptual model proved instrumental in developing the Psychiatric Review Form to examine patient safety events in inpatient psychiatry. Using this form, three medical record abstractors found that between 11.1-26.6% of charts screened positive for a potential patient safety event in the three hospitals. Common patient safety incidents included adverse drug reactions, patient violence, falls, and drug administration events.

Discussion: This study provides the first systematic epidemiological examination of patient safety in hospital-based psychiatry, which served as the foundation for planning a larger study among a random sample of hospitals statewide. Epidemiological research on patient safety in psychiatry has significant policy implications and can inform targeted strategies to prevent medical errors and reduce adverse events, enhancing the provision of safe clinical care for this vulnerable patient population.