Changes in Early Psychosis Service Provision: A File Audit

Abstract

The services increased their provision of "guideline concordant" care for early psychosis. The audit proved useful to monitor performance, to demonstrate improvements in care and to identify those areas of service provision and documentation in need of improvement.

Quality improvement in early psychosis treatment: The use of a file audit

“…Clients were excluded if they had a hospital admission only, and were not followed up by community services in Northern Sydney. These criteria contrast with those of the 1999 cohort from Gorrell et al (2004) which included all clients who received any in-patient or community treatment in the area over a six month period (N ¼ 74).…”

“…Aspects of assessment such as routine physical examinations (particularly assessment of weight), formal assessments of involuntary movements and comprehensive re-assessments of symptoms at three-to-six months were also recommended for improvement. Gorrell et al (2004) observed that some file audit indicators might provide an underestimate of service provision when interventions were not documented in the file or could not be reliably identified by auditors. It is likely that some services, such as group programs, were underestimated by using the file audit methodology alone and additional sources may be required to ensure accurate data regarding these aspects of service provision (Schachter & Kleinman, 1998;Young, Sullivan, Burnam, & Brook, 1998).…”

“…The current study assessed 19 aspects of service provision including timeliness, psychosocial interventions, medications prescribed, trauma, assessment, case management tasks and family work. Unlike the previous study (Gorrell et al, 2004), which was conducted retrospectively and independently by researchers, this audit was conducted by the early psychosis coordinator, concurrent with service provision and in consultation with the clinicians directly responsible for the medical records examined. A quality improvement process was utilized whereby each file was audited six months into treatment.…”

“…Previous research used file audit as a methodology to assess the dissemination of national evidence-based guidelines for early psychosis intervention via staff training and service restructuring (Gorrell et al, 2004). Significant improvements were demonstrated on ten of 24 clinical indicators, measuring psychosocial interventions, prescribing practices, family intervention and continuity of care.…”

“…Several aspects of care were identified for further improvement and the limitations of the file audit methodology discussed (Gorrell et al, 2004). Aims: The current project aimed to: (i) Facilitate further improvement in early psychosis services through the introduction of local clinical guidelines, the provision of staff training and the provision of feedback to clinicians during the audit process.…”