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The impact of the Emergency Department target upon the discharge decision for people who self-harm

The impact of the Emergency Department target upon the discharge decision for people who self-harm The purpose of this paper is to consider the influence of the Emergency Department (ED) target wait time upon the discharge decision in ED, specifically for patients who have self-harmed. Pressures to discharge patients to avoid breaching the 4-h target wait time, potentially increase the risk of adverse responses from clinicians. For the patient who has self-harmed, such interactions may be experienced as invalidating and may result in adverse outcomes.Design/methodology/approachSecondary data analysis was applied to the retrospective referral data of a Mental Health Liaison Team (MHLT), collected over a period of 11 months from a single hospital in the North of England. In total, 734 episodes of care were referred to the team from ED, where the primary presentation was recorded as self-harm.FindingsOver half of patients referred to the MHLT from ED having self-harmed were seen after already breaching the target and the potential for a more restrictive outcome reduced. Of those patients seen within 4 h, the potential for a more restrictive treatment option was increased.Practical implicationsRecommendations to improve the patient journey for those who have self-harmed include mental health triage and treatment in clinical areas outside of the target.Social implicationsThis study challenges the concept of the target as being realistic and attainable for patients who have self-harmed.Originality/valueThis exploratory study provides a starting point from which to explore the impact of the target time upon discharge decisions and clinical outcomes specifically for those who have self-harmed. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Public Mental Health Emerald Publishing

The impact of the Emergency Department target upon the discharge decision for people who self-harm

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References (48)

Publisher
Emerald Publishing
Copyright
© Emerald Publishing Limited
ISSN
1746-5729
DOI
10.1108/jpmh-01-2019-0003
Publisher site
See Article on Publisher Site

Abstract

The purpose of this paper is to consider the influence of the Emergency Department (ED) target wait time upon the discharge decision in ED, specifically for patients who have self-harmed. Pressures to discharge patients to avoid breaching the 4-h target wait time, potentially increase the risk of adverse responses from clinicians. For the patient who has self-harmed, such interactions may be experienced as invalidating and may result in adverse outcomes.Design/methodology/approachSecondary data analysis was applied to the retrospective referral data of a Mental Health Liaison Team (MHLT), collected over a period of 11 months from a single hospital in the North of England. In total, 734 episodes of care were referred to the team from ED, where the primary presentation was recorded as self-harm.FindingsOver half of patients referred to the MHLT from ED having self-harmed were seen after already breaching the target and the potential for a more restrictive outcome reduced. Of those patients seen within 4 h, the potential for a more restrictive treatment option was increased.Practical implicationsRecommendations to improve the patient journey for those who have self-harmed include mental health triage and treatment in clinical areas outside of the target.Social implicationsThis study challenges the concept of the target as being realistic and attainable for patients who have self-harmed.Originality/valueThis exploratory study provides a starting point from which to explore the impact of the target time upon discharge decisions and clinical outcomes specifically for those who have self-harmed.

Journal

Journal of Public Mental HealthEmerald Publishing

Published: Jun 2, 2020

Keywords: Self-harm; Emergency Department; Target; Clinical outcomes; Mental health liaison; Wait times

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