Enhanced Patient Observation (EPO) for risk of self-harm or suicide
NIHR159868: The acceptability, effectiveness and cost-effectiveness of Enhanced Patient Observation (EPO) for risk of self-harm or suicide on psychiatric wards.
Suicide prevention in hospitals is an important national health priority. Enhanced patient observation (EPO) or enhanced nursing observation is a clinical intervention commonly used on hospital wards in England to support patients thought to be at risk of self-harm or suicide. It includes the practices of continuous and intermittent observations, which aim to help patients feel safe and to stop them from hurting themselves. However, some patients can find them threatening or invasive. We also don't know if it actually works to keep patients safe.
In this project our research team, including lived experience experts, plans to carry out a set of studies to learn more about the acceptability and effectiveness of EPO in reducing risk of self-harm and suicide.
Our project seeks to answer the following research questions, which psychiatric patients and staff explain are important to them:
- Is Enhanced Patient Observation (EPO) acceptable to psychiatric inpatients and ward staff?
- Is it used differentially for specific patient groups?
- Is EPO effective and cost-effective in reducing risk of self-harm (SH) and suicide during psychiatric admission?
- Could EPO be improved? If so, what training or patient/carer resources are needed for this?
First, we will talk to current inpatients, carers and ward staff about their experiences of EPO and any suggestions they have to make it better.
We will also collect data from all NHS mental health trusts in England on how much they use EPO on wards and what it costs.
We will use anonymised electronic patient records in a smaller number of NHS trusts to identify patients nursed under EPO and compare them with those who are not. These analyses will work out whether EPO works in reducing self-harm and suicide. Using cost data, we will also work out whether EPO is worth the money.
Our lived experience experts will then co-lead a series of workshops for patients and clinical staff to discuss our findings, working out how to provide better care and make sure patients feel safe. We will co-design staff training, patient/carer information, and policy guidelines to help staff support inpatients by improving the quality of care.
Special Interest Group
The UCL Special Interest Group (SIG) in Self-Harm and Suicide is an interdisciplinary group of UCL researchers and clinicians from our partner NHS Trusts conducting clinical and public health research on self-harm, suicide attempt and suicide.
If you are a UCL researcher and/or clinicians from our partner NHS Trusts interested in clinical and public health research on self-harm, suicide attempt and suicide, please register your interest in joining the SIG by entering your details at this link, or find out more on our website.
A list of support services has been compiled for anyone participating in UCL research studies on suicide or self-harm. It outlines support services for people who might feel at risk of self-harm and is found at this link: https://www.ucl.ac.uk/psychiatry/about/support-sources.
Project team
Principal Investigator - Alexandra Pitman, UCL
PPI lead - Sarah Rowe, UCL
For any enquiries, please email SHproject@ucl.ac.uk
Co-investigators
Fiona Nolan, North London NHS Foundation Trust
Karen Lascelles, Oxford Health NHS Foundation Trust
TaShA, Lived Experience Co-investigator
David Osborn, UCL
Neil Davies, UCL
Justin Yang, UCL
Robert Stewart, King’s College London (KCL)
Derek King, London School of Economics (LSE)
Study sponsor
North London NHS Foundation Trust
Funder
