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Wolfram Kawohl Psychiatry

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Prof. Dr. med. Wolfram Kawohl, Chief physician and head of the clinic for psychiatry and psychotherapy, Psychiatrische Dienste Aargau AG, Brugg / ANQ Board member and Psychiatry QA

How does your hospital use the ANQ measurement data?

We take a very close look at the published results, even at the level of senior management and the supervisory board. A very good example would be freedom-restricting coercive measures (RMs). For years our hospital resorted to them frequently. But as a psychiatrist you prefer your patients to have as much autonomy as possible. Hence, we decided to designate the reduction of RMs a strategic goal and we review our achievements in this regard regularly using the ANQ data. It has paid off - use of these here is now below the average for Switzerland. And we have reduced the use of restraint and isolation by around two thirds since 2016.

“The ANQ measurements relating to psychiatry involve real patient-specific parameters, something that is extremely welcome.”

Do you evaluate ANQ results in-house?

Yes, we distribute the ANQ publications in-house. We particularly look at RMs over the course of the year. In our ‘Innovationsprogramm offene Psychiatrie’ project group designed to promote more openness in psychiatry, we analyse the figures every three months, which I then summarise and report to the management committees.

What do you gain from the direct comparison with other hospitals?

Benchmarking is always important. It allows us to determine where we stand in comparison with others. The fact that for some time we had been recording more RMs in comparison to other facilities certainly helped us to realise that something had to change. I suspect that if we only had the statistics for our hospital alone, there would not have been the same incentive to do something.

“I hope that ANQ will become even more relevant in the future. Here we have everyone involved sitting at the same table, exchanging ideas directly. This is unique.”

Do you also exchange data with other hospitals?

There is a considerable amount of networking going on, not only within ANQ. One of my many responsibilities as a senior consultant is serving on the board of the SVPC - the Swiss Association of Psychiatric Consultants - and I regularly see colleagues from other hospitals who also provide data to the ANQ and are therefore also involved in benchmarking activities.

We selectively look for other institutions making efforts to reduce RMs, for example. We visited those that we knew had a much lower rate of the use of RMs and sought their advice. But some hospitals are learning from us too. Take outpatient care, for example, for which we have developed certain treatment methods and also employ home treatment.

Speaking of home treatment, your hospital has recently published a study on this.

The study was designed by my predecessor; I was only involved in the final part.

It also dealt with ways in which we can extend the comparison of quality. The study used HoNOS as a core indicator to identify changes. Successfully too. It makes complete sense for use to proceed in this way because we collect the ANQ data anyway. And it’s also reliable, especially since we are already proficient in using the HoNOS rating scale.

So are the ANQ’s HoNOS and BSCL indicators suitable for use in connection with hospital outpatient care?

Yes, and I think it’s right that we not only undertake reviews at the hospital level, but over the whole of outpatient care too. At the very least this needs to be taken into consideration, as in Switzerland in the case of the latter, the emphasis is placed on psychiatrists in their own practice. Institutions’ outpatient clinics have a complementary function and complement social psychiatry facilities that provide psychiatrists, psychologists, healthcare professionals and social workers.

What important quality data relating to psychiatry do you think should also be registered?

Additional surveys of somatic medicine would be useful to provide information on falls and pressure ulcers. Also, inpatient suicide rates could be looked at more closely. We have also been told by our patients themselves that the 53-question BSCL questionnaire is too long. We need to develop a better, quicker tool - or at least digitise the data collection.

And, going beyond psychiatry, I’d also ask the question: why are RMs only recorded for psychiatry? People are restrained in every intensive care unit in an acute hospital, but also in geriatric acute care and during rehabilitation.

“Being able to assess the quality of outpatient care using data that we collect anyway makes sense in so many ways.”

Photos: © Geri Krischker / ANQ