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Updated: Jun 9, 2026

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
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A Mixed Methods Feasibility Study of a Clinical Decision Support System Designed to Assess Risk for Aggression and

Maria Ameel1,2, Tiina Talja1,2, Jaakko Varpula2

  • 1Psychiatry and HUS NRC, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

International Journal of Mental Health Nursing
|June 8, 2026
PubMed
Summary

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The Finnish electronic Dynamic Appraisal of Situational Aggression combined with the Aggression Prevention Protocol (eDASA+APP) is feasible for adult mental health units. This clinical decision support system aids aggression prevention and proactive nursing interventions.

Area of Science:

  • Mental Health Nursing
  • Clinical Decision Support Systems
  • Aggression Management

Background:

  • The electronic Dynamic Appraisal of Situational Aggression combined with the Aggression Prevention Protocol (eDASA+APP) is a system to prevent aggression.
  • Previous testing occurred in Australian forensic psychiatry.
  • Adaptation is needed for new clinical and linguistic contexts.

Purpose of the Study:

  • To examine the feasibility of the Finnish version of the eDASA+APP.
  • To assess its usability and impact on nursing practices in mental health inpatient units.

Main Methods:

  • Mixed methods approach in four Finnish mental health inpatient units.
  • Nurses completed an online learning module and used the eDASA+APP for two weeks.
  • Quantitative and qualitative data collected on documentation and feasibility.
Keywords:
aggressionclinical decision support systemelectronic health recordsrisk assessmentrisk management

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Main Results:

  • The eDASA+APP was perceived as easy to use and beneficial for aggression prevention.
  • Increased documentation of risk assessments and interventions observed.
  • The e-learning module was adequate, though less practical for older adult units.

Conclusions:

  • The Finnish eDASA+APP is feasible and beneficial for adult mental health inpatient units.
  • Supports wider implementation in adult services.
  • Further feasibility testing in older adult services is recommended.