Administrative Errors Blamed For Half Of Missed Psychiatric Appointments - Annual Meeting Of The Royal College Of Psychiatrists

Main Category: Psychology / Psychiatry
Article Date: 05 Jul 2008 - 0:00 PDT

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Administrative errors could be responsible for over half of patients with mental health problems failing to turn up for their hospital appointments, a study conducted in Belfast has shown.

According to the research, which was presented on Friday, 4 July at the Royal College of Psychiatrists' Annual Meeting, a substantial minority of these patients suffer from severe mental health disorders and may be at risk of suicide.

Dr Ashling O'Hare, a specialist registrar in adult psychiatry at the South Eastern Health and Social Care Trust, Belfast, Northern Ireland, and colleagues, used the hospital IT system to identify all the patients - some 352 - who had been recorded as 'open' on the caseload of a single consultant psychiatrist. These patients had not been issued with an outpatient appointment for over a year.

The researchers analysed the reasons for this 'loss of follow-up' in 69 of the patients. They found that in 52 per cent of the cases, administrative mistakes were the main reason for patients not turning up for their appointments.

In half of the cases where administrative errors had occurred, a clinical decision to discharge the patient had not been recorded on the IT system. In the other half, no further appointments had been generated despite the need for this being indicated as part of the management plan.

Indeed, in 35 per cent of the cases, the onus to arrange a further appointment had been placed on the patient, despite the fact that 12 per cent of them had severe mental illness. In two thirds of the cases, some level of risk - usually of suicide - was identified.

The authors concluded that it is unacceptable for patients to become lost to follow-up because of system errors. Documentation of clinical decisions is crucial, they said. An effective administrative system and policy for dealing with patients who disengage from services are vital components of the governance system required to manage risk.

Reference
The Annual Meeting of the Royal College of Psychiatrists, Imperial College, London, 1 - 4 July 2008

The Royal College of Psychiatrists
www.rcpsych.ac.uk