Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case–crossover study
Objective Clinician narrative style in electronic health records (EHR) has rarely been investigated. Clinicians sometimes record brief quotations from patients, possibly more frequently when higher risk is perceived. We investigated whether the frequency of quoted phrases in an EHR was higher in tim...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-04-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/4/e036186.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846141917481402368 |
|---|---|
| author | Rina Dutta Robert Stewart André Bittar |
| author_facet | Rina Dutta Robert Stewart André Bittar |
| author_sort | Rina Dutta |
| collection | DOAJ |
| description | Objective Clinician narrative style in electronic health records (EHR) has rarely been investigated. Clinicians sometimes record brief quotations from patients, possibly more frequently when higher risk is perceived. We investigated whether the frequency of quoted phrases in an EHR was higher in time periods closer to a suicide attempt.Design A case–crossover study was conducted in a large mental health records database. A natural language processing tool was developed using regular expression matching to identify text occurring within quotation marks in the EHR.Setting Electronic records from a large mental healthcare provider serving a geographic catchment of 1.3 million residents in South London were linked with hospitalisation data.Participants 1503 individuals were identified as having a hospitalised suicide attempt from 1 April 2006 to 31 March 2017 with at least one document in both the case period (1–30 days prior to admission) and the control period (61–90 days prior to admission).Outcome measures The number of quoted phrases in the control as compared with the case period.Results Both attended (OR 1.05, 95% CI 1.02 to 1.08) and non-attended (OR 1.15, 95% CI 1.04 to 1.26) clinical appointments were independently higher in the case compared with control period, while there was no difference in mental healthcare hospitalisation (OR 0.99, 95% CI 0.98 to 1.01). In addition, there was no difference in the levels of quoted text between the comparison time periods (OR 1.09, 95% CI 0.91 to 1.30).Conclusions This study successfully developed an algorithm to identify quoted speech in text fields from routine mental healthcare records. Contrary to the hypothesis, no association between this exposure and proximity to a suicide attempt was found; however, further evaluation is warranted on the way in which clinician-perceived risk might be feasibly characterised from clinical text. |
| format | Article |
| id | doaj-art-a61c1b7723cf4a3ab704d4bfd5c2dd34 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-a61c1b7723cf4a3ab704d4bfd5c2dd342024-12-04T02:35:13ZengBMJ Publishing GroupBMJ Open2044-60552020-04-0110410.1136/bmjopen-2019-036186Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case–crossover studyRina Dutta0Robert Stewart1André Bittar2Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKSouth London and Maudsley NHS Foundation Trust, London, UKDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKObjective Clinician narrative style in electronic health records (EHR) has rarely been investigated. Clinicians sometimes record brief quotations from patients, possibly more frequently when higher risk is perceived. We investigated whether the frequency of quoted phrases in an EHR was higher in time periods closer to a suicide attempt.Design A case–crossover study was conducted in a large mental health records database. A natural language processing tool was developed using regular expression matching to identify text occurring within quotation marks in the EHR.Setting Electronic records from a large mental healthcare provider serving a geographic catchment of 1.3 million residents in South London were linked with hospitalisation data.Participants 1503 individuals were identified as having a hospitalised suicide attempt from 1 April 2006 to 31 March 2017 with at least one document in both the case period (1–30 days prior to admission) and the control period (61–90 days prior to admission).Outcome measures The number of quoted phrases in the control as compared with the case period.Results Both attended (OR 1.05, 95% CI 1.02 to 1.08) and non-attended (OR 1.15, 95% CI 1.04 to 1.26) clinical appointments were independently higher in the case compared with control period, while there was no difference in mental healthcare hospitalisation (OR 0.99, 95% CI 0.98 to 1.01). In addition, there was no difference in the levels of quoted text between the comparison time periods (OR 1.09, 95% CI 0.91 to 1.30).Conclusions This study successfully developed an algorithm to identify quoted speech in text fields from routine mental healthcare records. Contrary to the hypothesis, no association between this exposure and proximity to a suicide attempt was found; however, further evaluation is warranted on the way in which clinician-perceived risk might be feasibly characterised from clinical text.https://bmjopen.bmj.com/content/10/4/e036186.full |
| spellingShingle | Rina Dutta Robert Stewart André Bittar Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case–crossover study BMJ Open |
| title | Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case–crossover study |
| title_full | Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case–crossover study |
| title_fullStr | Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case–crossover study |
| title_full_unstemmed | Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case–crossover study |
| title_short | Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case–crossover study |
| title_sort | clinician recalled quoted speech in electronic health records and risk of suicide attempt a case crossover study |
| url | https://bmjopen.bmj.com/content/10/4/e036186.full |
| work_keys_str_mv | AT rinadutta clinicianrecalledquotedspeechinelectronichealthrecordsandriskofsuicideattemptacasecrossoverstudy AT robertstewart clinicianrecalledquotedspeechinelectronichealthrecordsandriskofsuicideattemptacasecrossoverstudy AT andrebittar clinicianrecalledquotedspeechinelectronichealthrecordsandriskofsuicideattemptacasecrossoverstudy |