Measuring process indicators and adverse events to assess the quality of care for inpatients with psychosis

Figures & data

Figure 1. Quality indicators as assessed in current study (with the exception of structure indicators) based upon the Donabedian Framework.

Table 1. Study sample characteristics and associations with adverse events during admission (n = 299).

Variables	With adverse event n = 118 (39%)	No adverse event n = 181 (61%)	p Value
Gender, male/female, n (%)	79 (66.9)/39 (33.1)	121(66.9)/60 (33.1)	0.99
Age, median (IQR)	33 (23–39)	30 (23–42)	0.85
Diagnosis, n (%)			0.64
Schizophrenia	67 (56.8)	105 (58.0)
Psychosis NOS	23 (19.5)	36 (19.9)
Schizophreniform	6 (5.1)	12 (6.6)
Schizoaffective	15 (12.7)	18 (9.9)
Bipolar with psychotic features	7 (5.9)	7 (3.9)
Other psychotic disorders^a	0	3 (1.7)
Length of stay in days, median (IQR)	44 (27-66)	21 (10-43)	<0.001
Compulsory admission, n (%)	68 (57.6)	81 (44.8)	0.04
Seclusion during admission, n (%)	22 (18.6)	13 (7.2)	0.003

^a Other psychotic disorder can be specified as brief psychotic disorder and psychotic disorder due to medical condition. NOS: Not otherwise specified; GAF: global assessment of functioning; IQR: interquartile range. Significant findings are shown in bold.

Table 2. Rates of process indicators in admissions (n = 299).

Physical health risk factors	Frequencies (%)
Tobacco use	55
Cannabis misuse or abuse	28
Alcohol misuse or abuse	8
Anti-diabetic medication	6
Polypharmacy^a	6
Obesity as comorbidity	6
Antihypertensive medication	5
Lipid lowering medication	2
Physical health measurements
Glucose and lipids screening	75
Blood pressure measurement	71
Weight
At least one measurement	69
(Range in kg)	(37–137)
Treatment interventions during all admissions
Occupational therapy	70
Initiation of new antipsychotic medication	63
Family involvement	43
Social worker involved	25
Dietary consultation	10
CBT initiated	4
Tobacco cessation in smokers	1

kg: kilograms; CBT: cognitive behavioural therapy.

^a Polypharmacy was defined by five or more medications.

Table 3. Types and frequencies of adverse events (n = 235).

Type of adverse event	n (%)	n per 100 admissions	n per 1000 patient days
1. Adverse drug reactions of which:	93 (40)	31	8
Induced by SGA	50
Induced by FGA	41
Induced by other medication^a	2
2. Patient elopement	40 (17)	13	4
3. Assault	31 (13)	10	3
4. Medication error	27 (11)	9	2
5. Contraband on unit	26 (11)	9	2
6. Other patient safety events^b	9 (4)	3	<1
7. Sexual contact	5 (2)	2	<1
8. Self-harm or injury to self	4 (2)	1	<1
9. Patient fall	0	0	0
Total	235 (100)	79	21

SGA: second generation antipsychotic; FGA: first generation antipsychotic.

^a Other medication = mood stabilizer and somatic medication.

^b Patient readmission within three days or not allowed smoking at wards.