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Meeting standards set for non self-harm presentations to emergency departments

Published online by Cambridge University Press:  13 June 2014

Diane Mullins ,
Siobhan MacHale  and
David Cotter
Diane Mullins*
Affiliation:
Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
Siobhan MacHale
Affiliation:
Department of Psychiatry, Beaumont Hospital, Dublin 9
David Cotter
Affiliation:
Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
*
*Correspondence E-mail: dianetmullins@rcsi.ie
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Abstract

Objectives: The commonest psychiatric presentation in most emergency departments (EDs) is deliberate self-harm. However, there are other significant categories of psychiatric presentation which include alcohol and substance misuse, acute psychosis and mood disorder. In addition to the NICE Guidelines for deliberate self-harm, there are good practice guidelines available for the management of other psychiatric attendances to the ED. The aim of this study was to identify the psychiatric attendances other than deliberate self-harm to Beaumont Hospital ED over a 12-month period with the objective of studying the rates and characteristics of attendances and to investigate whether good practice guidelines were met.

Method: From a total of 657 psychiatric attendances other than deliberate self-harm which were recorded, data was collected on demographics, provision of a psychosocial assessment and adherence to good practice guidelines.

Results: Alcohol (38%) was the most common reason for presentation. Of the total number of attendees, only 44% received a psychosocial assessment compared to 59% of attendees who had presented following deliberate self-harm during the same 12-month period.

Conclusions: The attendees who did not receive a psychosocial assessment represent a vulnerable group in which the levels of psychosocial assessment need to be improved in order to meet good practice guidelines standards of care.

Keywords

Emergency departmentPsychosocial assessmentGood practice guidelines
Type
Original papers
Information
Irish Journal of Psychological Medicine , Volume 28 , Issue 4 , December 2011 , pp. 185 - 190
Copyright
Copyright © Cambridge University Press 2011

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References

1.Cessar, S, Hodgkiss, A, Ramirez, A, Williams, D. Mental health presentations to an inner-city accident and emergency department. Psych Bull 2002; 26: 134–136.CrossRefGoogle Scholar
2.National Institute for Clinical Excellence Clinical Guidelines 16: Self-harm: the short term physical and psychological management and secondary prevention of self harm in primary and secondary care. NICE: London, July 2004.Google Scholar
3.Ramirez, A, House, A. ABC of mental health: common mental health problems in the general hospital. Br Med J 1997; 314: 679–1681.CrossRefGoogle Scholar
4.Royal College of Psychiatrists, Royal College of Nursing, The College of Emergency medicine and the Royal College of Physicians. Managing urgent mental health needs in the acute trust: a guide by practitioners, for managers and commissioners in England and Wales. Academy of Medical Royal Colleges; 2008.Google Scholar
5.Bolton, J. Accident and emergency psychiatry. Psychiatry 2006; 5(3): 73–76.CrossRefGoogle Scholar
6.Peters, J, Brooker, C, McCabe, C, Short, N. Problems encountered with opportunistic screening for alcohol-related problems in patients attending an accident and emergency department. Addiction 1998; 93: 589–594.CrossRefGoogle ScholarPubMed
7.Wright, S, Moran, L, Meyrick, M, O'Connor, , Tourquet, R. Intervention by an alcohol health worker in an accident and emergency department. Alcohol Alcoholism 1998; 33: 651–656.CrossRefGoogle Scholar
8.Thom, B, Herring, R, Judd, A. Identifying alcohol-related harm in young drinkers: the role of accident and emergency departments. Alcohol Alcholism 1999; 34: 910–915.CrossRefGoogle ScholarPubMed
9.Patton, R, Strang, J, Birtles, C, Crawford, M J. Alcohol: a missed opportunity. A survey of all accident and emergency departments in England. Emerg Med J 2007; 24: 529–531.CrossRefGoogle ScholarPubMed
10.Richmond, R, Anderson, P. Research in general practice for smokers and excessive drinkers in Australia and the UK. I. Interpretation of results. Addiction 1994; 89: 35–40.CrossRefGoogle ScholarPubMed
11.Orford, J, Edwards, G. Alcoholism: a comparison of treatment and advice, with a study of the influence of marriage. Oxford: Oxford University Press, 1977.Google Scholar
12.Chick, J, Lloyd, G, Crombie, E. Counselling problem drinkers in medical wards: a controlled study. BMJ 1985; 290: 965–967.CrossRefGoogle ScholarPubMed
13.Wallace, P, Cutler, S, Haines, A. Randomised controlled trial of general practice intervention in patients with excessive alcohol consumption. BMJ 1988; 297: 663–668.CrossRefGoogle ScholarPubMed
14.Bien, T, Miller, W, Tonigan, J. Brief interventions for alcohol problems: a review. Addiction 1993; 88: 315–336.CrossRefGoogle ScholarPubMed
15.D'Onofrio, G, Pantalon, MV, Degutis, LC, Fiellin, DA, O'Connor, PG. Development and implementation of an emergency practitioner-performed brief intervention for hazardous and harmful drinkers in the emergency department. Acad Emerg Med 2005; 12: 249–256.Google ScholarPubMed
16.Crawford, MJ, Patton, R, Touquet, Ret al.Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomized controlled trial. Lancet 2004; 364: 1334–1339.CrossRefGoogle Scholar
17.Wright, S, Moran, L, Meyrick, M, O'Connor, R, Touquet, R. Intervention by an alcohol health worker in an accident and emergency department. Alcohol Alcohol 1998; 33: 651–656.CrossRefGoogle Scholar
18.Love, AC, Greenberg, MR, Brice, M, Weinstock, M. Emergency department screening and intervention for patients with alcohol-related disorders: a pilot study. J Am Osteopath Assoc 2008; 108: 12–20.Google ScholarPubMed
19.Academic ED SBIRT Research Collaborative. The impact of screening, brief intervention, and referral for treatment on emergency department patients' alcohol use. Ann Emerg Med 2007; 50: 699–710.CrossRefGoogle Scholar
20.Blow, FC, Barry, KL, Walton, MAet al.The efficacy of two brief intervention strategies among injured, at-risk drinkers in the emergency department: impact of tailored messaging and brief advice. J Stud Alcohol 2006; 67: 568–578.CrossRefGoogle ScholarPubMed
21.Longabaugh, R, Woolard, RE, Nirenberg, TDet al.Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. J Stud Alcohol 2001; 62: 806–816.CrossRefGoogle ScholarPubMed
22.D'Onofrio, G, Degutis, LC. Preventive care in the emergency department: screening and brief intervention for alcohol problems in the emergency department: a systematic review. Acad Emerg Med 2002; 9: 627–638.CrossRefGoogle ScholarPubMed
23.Hungerford, DW, Pollock, DA, Todd, KH. Acceptability of emergency department-based screening and brief intervention for alcohol problems. Acad Emerg Med 2000; 7: 1383–1392.CrossRefGoogle ScholarPubMed
24.Cunningham, RM, Harrison, SR, McKay, MPet al.National survey of emergency department alcohol screening and intervention practices. Ann Emerg Med 2010; 55: 556–562.CrossRefGoogle ScholarPubMed
25)Patton, R, Strang, J, Birtles, C, Crawford, MJ. Alcohol: a missed opportunity. A survey of all accident and emergency departments in England. Emerg Med J 2007; 24: 529–531.CrossRefGoogle ScholarPubMed
26.Royal College of Psychiatrists Medicine Council Report CR118: Psychiatric services to accident and emergency departments. London: British Association for Accident and Emergency, February 2004.Google Scholar
27.Kaplan, H, Sadock, B. Pocket Handbook of Emergency Psychiatric Medicine. Lippincott, Williams & Wilkins; 1993.Google Scholar
28.Scully, J. A brief review of psychiatry in the late 20th century. Hosp Physician 1997; 11: 13–16.Google Scholar
29.Gunnell, D, Bennewith, O, Peters, T, House, A, Hawton, K. The epidemiology and management of self-harm amongst adults in England. J Public Health 2004; 27: 67–73.CrossRefGoogle ScholarPubMed
30.Horrocks, J, Price, S, House, A, Owens, D. Self-injury attendances in the accident and emergency department. Br J Psych 2003; 183: 34–39.CrossRefGoogle ScholarPubMed
31.Crawford, M, Wessely, S. Does initial management affect the rate of repetition of deliberate self harm? Cohort study. BMJ 1998; 317: 985–990.CrossRefGoogle ScholarPubMed
32.Bennewith, O, Gunnell, D, Peters, T, Hawton, K, House, A. Variations in the hospital management of self harm in adults in England: observational study. BMJ 2004; 328: 1108–1109.CrossRefGoogle ScholarPubMed
33.Bergen, H, Hawton, K. Variations in time of hospital presentations for deliberate self-harm and their implications for clinical services. J Affect Dis 2007; 98: 227–237.CrossRefGoogle ScholarPubMed
34.Brakoulias, V, Ryan, C, Byth, K. Patients with deliberate self-harm seen by a consultation-liaison service. Australian Psych 2006; 14(2): 192–197.CrossRefGoogle ScholarPubMed
35.Hawton, K, Harriss, L, Sinkin, S, Bale, E, Bond, A. Self-cutting: patient characteristics compared to self-poisoners. Suicide Life Threat Behav 2004; 34(3): 199–208.CrossRefGoogle ScholarPubMed
36.www.hse.ie/eng/staff/FactFile/County_Information/Dublin/Beaumont%20Hospital%20Dublin/Beaumont_Hospital_Dublin.html#ed. Accessed Oct 31, 2010.Google Scholar
37.Mackway-Jones, K. Emergency Department: Manchester Triage Group. London: BMJ Publishing, 1997.Google Scholar
38.Rhodes, M, Carlson, G, Dunn, J, Malata, C, Merry, C, Milne, D. All day drinking – its impact on an accident and emergency department. Health Trends 1990; 22: 120–121.Google Scholar
39.Pirmohamed, M, Brown, C, Owens, Let al.The burden of alcohol misuse on an inter-city general hospital. QJM 2000; 93: 291–295.CrossRefGoogle Scholar
40.Waller, S, Thom, B, Harris, S, Kelly, M. Perceptions of alcohol-related attendances in acceident and emergency departments in England: a national survey. Alcohol Alcoholism 1998; 33: 354–361.CrossRefGoogle ScholarPubMed
41.Hay, E, Bekerman, L, Rosenber, G, Peled, R. Quality assurance of nurse triage: consistency of results over three years. Am J Emerg Med 2001; 19: 113–117.CrossRefGoogle ScholarPubMed
42.Happell, B, Summers, M, Pinikahana, J. The triage of psychiatric patients in the hospital emergency departments: a comparison between emergency department nurses and psychiatric consultations. Accid Emerg Nurs 2002; 10: 65–71.CrossRefGoogle Scholar
43.Broadbent, M, Jarman, H, Berk, M. Improving competence in emergency mental health triage. Accid Emerg urs 2002; 10: 155–162.CrossRefGoogle ScholarPubMed
44.Clarke, D, Hughes, L. Psychiatric nurses in hospital emergency departments. Can Nurse 2002; 98: 23–26.Google ScholarPubMed
45.Smart, D, Pollard, C, Walpole, B. Mental health triage in emergency medicine. Aust NZ J Psych 1999; 33: 57–66.CrossRefGoogle ScholarPubMed
46.Kirby, M, Keon, W. Mental health, mental illness and addiction: overview of policies and programs in Canada. Interim Report of the Standing Senate Committee on Social Affairs, Science and Technology. Ottawa, Canada: November 2004.Google Scholar
47.Kirby, M, Keon, W. Out of the shadows at last: transforming mental health, mental illness and addiction services in Canada. The Standing Senate Committee on Social Affairs, Sciences and Technology. Ottawa, Canada: May 2006.Google Scholar
48.Australasian College for Emergency Medicine. The Australasian Triage Scale. November 2000. www.medeserv.com.au/acem/open/documents/triage.htmGoogle Scholar
49.Broadbent, M, Jarman, H, Berk, M. Improving competence in emergency mental health triage. Accid Emerg Nurs 2003; 10(3): 155–162.CrossRefGoogle Scholar
50.Brooker, C, Peters, J, McCabe, C, Short, N. The views of nurses to the conduct of a randomized controlled trial of problem drinkers in an accident and emergency department. In J Nurs Stud 1999; 36: 33–39.CrossRefGoogle Scholar
51.Charalambous, M. Alcohol and the accident and emergency department: a current review. Alcohol Alcoholism 2002; 37: 307–312.CrossRefGoogle ScholarPubMed
52.Danielsson, P, Rivara, F, Gentilello, L, Maier, R. Reasons why trauma surgeons fail to screen for alcohol problems. Arch Surg 1999; 134: 564–568.CrossRefGoogle ScholarPubMed
53.Hungerford, D, Pollock, D. Emergency department services for patients with alcohol problems: research directions. Acad Emerg Med 2003; 10: 79–84.CrossRefGoogle ScholarPubMed
54.Ockene, J, Adams, A, Hurley, T, Wheeler, E, Hebert, J. Brief physician and nurse practitioner delivered counseling for high-risk drinkers. Arch Int Med 1999; 159: 2198–2205.CrossRefGoogle ScholarPubMed
55.Mullins, D, MacHale, S, Cotter, D. Compliance with NICE guidelines in the management of self-harm. The Psychiatrist 2010; 34: 385–389.CrossRefGoogle Scholar
56.Williams, R, Vinson, DC. Validation of a single screening question for problem drinking. J Fam Pract 2001; 50: 307–312Google ScholarPubMed
57.Patton, R, Touquet, R. The Paddington Alcohol Test. Br J Gen Pract 2002; 52: 59.Google ScholarPubMed