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Understanding Re-Presentations Following Intentional Self-Harm: Insights from an Emergency Department Study

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23 diapositives · 336 Views · Sep 12, 2014

This study by Silke Kuehl and Dr. Kathy Nelson delves into factors contributing to intentional self-harm re-presentations in the Emergency Department (ED). The research aims to describe demographic and clinical characteristics, evaluate ED management, and identify personal or systemic reasons for re-presentation following self-harm incidents. By analyzing data from 48 individuals with 73 re-presentations, the study underscores the challenges in identifying and supporting this vulnerable population. Findings reveal gaps in documentation, risk assessments, and triage procedures, emphasizing the need for improved training, supervision, and cultural sensitivity within ED settings to better address the complex needs of individuals engaging in intentional self-harm.

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  1. ED RE-PRESENTATIONS FOLLOWING INTENTIONAL SELF-HARMSilke KuehlDr Kathy Nelson

  2. Overview Literature Aims & Objectives Methodology Findings Recommendations Conclusion

  3. The Literature Statistics Risk factors The young, the old and men Views…ED staff, patients

  4. Overcrowding

  5. Help from IT expert • Approximately 45,000 ED presentations in 2006 • 1865 people – 1 x ISH • 120 people – 393 presentations • Nearly half 58 re-presented w/in 1/52

  6. Aims & Objectives Describe factors contributing to people re-presenting • Objectives: • Describe demographic and clinical features • Describe and evaluate ED management • Identify personal or system reasons

  7. Intentional Self-harm Definition: • Attempted suicide • Suicidal ideation • Deliberate self-harm

  8. Methodology • Descriptive research • Retrospective review • Data extraction tool • Variables: • Person • Presentation • Inclusion/exclusion Sent Ethics proposal

  9. After Ethics • Retrieved data • Log book • Sample: • 48 people • 73 re-presentations • Analysis: SPSS

  10. Findings • Coding • Documentation/Assessments • Cultural input • Physical/mental health • Support people • Challenging behaviours • Time to re-presentation

  11. Coding • Patients are coded by their presenting complaint, irrespective of the intent • Identifying this population difficult • Previously identified 120 people presented 852 times

  12. Type of ISH • Overdose Burn • Laceration Gassing • Attempted hanging • Ingestion/insertion foreign body • Head injury • Stabbing self • Traffic • Jumping from a height

  13. Documentation/Assessment • Location of person often briefly described • Poor documentation of risk assessments • Inadequate triage assessment • Patient discharged without ED staff being aware

  14. Documentation/Assessment • Scenario: Person Y presented to ED with thoughts of killing his neighbour and suicidal thoughts. Y was assessed by the MH team and sent home. He arrived back in ED two days later. The triage nurse’s documentation is ‘Expected by CATT. Appears calm’ and allocated a code 4. CATT was delayed for three hours.

  15. Cultural Input • Maori presented 23% of sample (approx 14.3 % in population) • Nil input of Maori services • Increased risk of suicide if not connected to culture (Coupe, 2002)

  16. Physical/mental health Scenario: Person X presents with a deep laceration to the hand. It requires plastic surgery. He states he works in a professional occupation and got his hand caught in a grinder by accident. Person X states that he has no past medical history. Previous admission notes showed that he had attended two days previously distressed and suicidal.

  17. Physical/mental health • Ambulatory Care service – ‘quick’ • Nil checking of previous presentations • Nil highlighting on the IT system

  18. Support people

  19. Challenging Behaviours • Occurred in approximately 25% of presentations

  20. Time to re-presentation • 55% of re-presentations happened within one day (expected by MH: 22%/29%) • Also… • Decreased mental health services referral (88%/74%) • Decreased assessments by MH (66%/55%) • Admission rates 40% higher on re-presentation (23%/32%)

  21. Limitations • Retrospective data relies on staff documenting the real event • Once-only patient group probably included people that presented multiple times • Unable to obtain documentation by MH services

  22. Recommendations • Training and supervision • Psychiatric staff in ED • Cultural assessment/input

  23. Number of presentations? – no idea… ED important for providing care Population is vulnerable, distressed and at high risk of suicide Conclusion