Brown C S H, Lloyd K R
Department of Mental Health, University of Exeter, Exeter, UK.
Acta Psychiatr Scand Suppl. 2002(412):148-51. doi: 10.1034/j.1600-0447.106.s412.32.x.
To compare the clinical risk assessment of patients by psychiatrists working in different mental health service settings (low, medium and high security).
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.
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).
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.
比较在不同精神卫生服务环境（低、中、高安全级别）工作的精神科医生对患者的临床风险评估。
将被认为表明对他人有伤害风险的临床因素的可操作标准制定成一个简单的清单，其中包含明确的项目描述和定义（OP-RISK）。这被用于比较连续转诊至一家高安全级别的精神病医院的161名患者的前瞻性队列中的风险评估。
使用非结构化临床风险评估时，高安全级别服务机构内外工作的精神科医生对患者所构成风险的评估一致性较差（kappa=-0.006）。当将OP-RISK应用于临床风险评估时，一致性有所改善（kappa=0.742）。
将可操作标准应用于临床风险评估有助于整合不同的精神卫生服务环境。使用OP-RISK可能会促进向三级护理的转诊过程。
