Comparing clinical risk assessments using operationalized criteria

Objective:  To compare the clinical risk assessment of patients by psychiatrists working in different mental health service settings (low, medium and high security). Method:  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. Results:  Agreement on the risk posed by a patient between psychiatrists working outside and inside high secure services using unstructured clinical risk assessment was poor (κ=−0.006). When OP‐RISK was applied to the clinical risk assessments, agreement improved (κ=0.742). Conclusion:  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.