Consistent with the NHS quality agenda, Dept. of Health, 2011¹ there has been a drive to routinely incorporate outcome and performance measurement data in clinical practice. An absolute requirement within NHS services² are Patient-Rated Outcome Measures (PROMS) which are used by some Royal College of Psychiatry faculties to quantify outcomes, improve accountability, performance management and service. They can also be used to screen for common health problems and ensure the comprehensive assessment of complex Acquired Brain Injury (ABI) Patients who typically present with various neurological and psychiatric comorbidities.

The North Bristol NHS Trust Outpatient Clinic at The Frenchay Brain Injury Rehabilitation Centre and The Rosa Burden, Southmead Hospital, conducts new assessments and regular patient reviews for referrals from South West England. As part of a quality improvement initiative a semi-structured process of assessment was trialled, to improve patient experience by providing a comprehensive initial assessment, improving treatment productivity and reducing over-running clinics.

Method Referrals were audited and common reasons for referrals identified. Questionnaires and tools used in the clinic were reviewed and those most frequently used were compiled. The evidence for questionnaires utilized for different psychiatric comorbidities and applicability in ABI was examined in the literature. The finalized patient questionnaires booklet section and their sequence was decided based on expert peer recommendations and patient feedback. The collateral section was similarly developed with some questionnaires modified for operational reasons.

SECTION ONE: SELF RATED PRE-ASSESSMENT QUESTIONNAIRE

Rivermead Post Concussion Symptoms Questionnaire, Patient Health Questionnaire (15): Somatic Screen, Patient Health Questionnaire-9: Depression screen, General Anxiety Disorder 7: Anxiety screen, Mood Disorder Questionnaire: Bipolar Affective Disorder screen and the Civilian Version PTSD Checklist.

SECTION TWO: CARER/FAMILY PRE-ASSESSMENT QUESTIONNAIRE

Modified Overt Aggression Scale screen for aggression, Neuropsychiatry Inventory Questionnaire: assesses psychiatric symptoms in patients with neurological disorders

Outcome The final booklet was divided into three sections:

Patient-Rated, ObserverRated and Clinician Section. Consultation efficiency was improved with the Patient and Observer rated sections completed prior to the initial assessment. The checklist is used for all initial assessments with good uptake and allowed for standardization of clinical information gathering. PROMs for mood are collected at each clinic appointment with other domains repeated if abnormal at initial clinic assessment or clinically relevant.

References

1. Fossey M, Parsonage M. Outcomes and performance in liaison psychiatry: developing a measurement framework. Centre for Mental Health and Royal College of Psychiatrists Report June 2014.

2. Trigwell P, Kustow J, Santhouse A, et al. Framework for routine outcome measurement in liaison psychiatry (FROM-LP): faculty of liaison psychiatry royal college of psychiatrists faculty report. The Royal College of Psychiatrists 2015.

3. vretveit J, Zubkoff L, Nelson EC, et al. Using patient-reported outcome measurement to improve patient care. Int J Qual Health Care 2017 Oct 1;29(6):874879.