Comparing clinical risk assessments using operationalized criteria

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.