Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Affective Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.
BMJ Open. 2022 Apr 21;12(4):e050953. doi: 10.1136/bmjopen-2021-050953.
The overall objective was to analyse service-related factors involved in the complex processes that precede suicide in order to identify potential targets for intervention.
Explorative network analysis study of post-suicide root cause analysis data from Swedish primary and secondary healthcare.
217 suicide cases reported to the Swedish national root cause analysis database between 2012 and 2017.
A total of 961 reported incidents were included. Demographic data and frequencies of reported deficiencies were registered. Topology, centrality indices and communities were explored for three networks. All networks have been tested for robustness and accuracy.
Lack of follow-up, evaluations and insufficient documentation issues emerged as central in the network of major themes, as did the contributing factors representing organisational problems, failing procedures and miscommunication. When analysing the subthemes of deficiencies more closely, disrupted treatments and staffing issues emerged as prominent features. The network covering the subthemes of contributing factors also highlighted discontinuity, fragile work structures, inadequate routines, and lack of resources and relevant competence as potential triggers. However, as the correlation stability coefficients for this network were low, the results need further investigation. Four communities were detected covering nodes for follow-up, evaluation, cooperation, and procedures; communication, documentation and organisation; assessments of suicide risk and psychiatric status; and staffing, missed appointments and declined treatment.
The results of this study suggest that healthcare providers may improve patient safety in suicide preventive pathways by taking active measures to provide regular follow-ups to patients with elevated suicide risk. In some cases, declined or cancelled appointments could be a warning sign. Tentative results show organisational instability, in terms of work structure, resources and staffing, as a potential target for intervention, although this must be more extensively explored in the future.
总体目标是分析自杀前复杂过程中涉及的服务相关因素，以确定潜在的干预目标。
对瑞典初级和二级保健机构自杀根本原因分析数据库中 2012 年至 2017 年间报告的 217 例自杀案例进行探索性网络分析研究。
217 例报告给瑞典国家根本原因分析数据库的自杀案例。
共纳入 961 例报告事件。记录了人口统计学数据和报告缺陷的频率。探索了三个网络的拓扑结构、中心性指数和社区。所有网络均经过稳健性和准确性测试。
在主要主题网络中，缺乏随访、评估和文件记录不足等问题以及代表组织问题、程序失败和沟通不畅的促成因素成为核心问题。当更仔细地分析缺陷的子主题时，中断的治疗和人员配备问题成为突出特征。涵盖促成因素子主题的网络还突出了不连续性、脆弱的工作结构、不充分的常规、资源和相关能力的缺乏作为潜在触发因素。然而，由于该网络的相关稳定性系数较低，因此需要进一步研究结果。检测到四个社区，涵盖随访、评估、合作和程序；沟通、文件记录和组织；自杀风险和精神状态评估；以及人员配备、错过预约和拒绝治疗等方面的节点。
这项研究的结果表明，医疗保健提供者可以通过采取积极措施为高自杀风险的患者提供定期随访，从而提高预防自杀途径中的患者安全。在某些情况下，拒绝或取消预约可能是一个警告信号。初步结果显示，组织不稳定，包括工作结构、资源和人员配备，可能是干预的目标，尽管这需要在未来更广泛地探索。
