Estimating the link between service-user patient safety perceptions, incidents and subsequent contagion in acute mental health wards

Background Safety incidents are common in adult acute inpatient mental health services, and detrimental to all. Incidents spread via social contagion within the ward, but social contagion is difficult to quantify. Better measures of social contagion could support a milieu in which safety incidents are less likely to be prolonged, spread, or repeated, with widespread benefits.

The WardSonar project, based in the United Kingdom (UK), developed and evaluated a prototype digital safety monitoring tool to collect real-time information from patients on acute adult mental health wards, about their perceptions of ward safety. A prototype Wardsonar tool was developed from a collaborative, co-design approach, and implemented in real-world hospital settings. The current study aimed to understand whether the tool can help to predict incidents, by examining (i) the feasibility of capturing real-time feedback from patients about safety and (ii) how the resulting data related to quality and safety metrics.

This study was registered as ISRCTN14470430 on 10/January/2022.

Method Patients can record real-time perceptions of ward safety using the tool, and staff can access these as anonymous, aggregated data. The tool was implemented in the UK in six National Health Service adult acute mental health wards. A novel approach to analysis involved construction of an hour-by-hour dataset over each ward. This revealed relationships between quantity and content of patient reports, staffing, time of day, and ward incidents, per ward.

Results There is strong evidence that an incident leads to increased probability of further incidents within the next four hours. This supports the idea of social/behavioural contagion and puts a measure on the extent to which the contagion persists. COVID-19 impacted the research processes.

Conclusions There is potential to use the WardSonar digital tool for proactive real-time safety monitoring, to identify developing incidents and help staff to facilitate timely preventative or de-escalating interventions. Further refinement and testing in a post COVID-19 context are needed.