ED RE-PRESENTATIONS FOLLOWING INTENTIONAL SELF-HARM Silke Kuehl Dr Kathy Nelson.
Emergency department re-presentations following intentional self-harm
-
Upload
mhf-suicide-prevention -
Category
Health & Medicine
-
view
607 -
download
1
description
Transcript of Emergency department re-presentations following intentional self-harm
![Page 1: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/1.jpg)
ED RE-PRESENTATIONS FOLLOWING INTENTIONAL SELF-HARM
Silke Kuehl
Dr Kathy Nelson
![Page 2: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/2.jpg)
Overview Literature Aims & Objectives Methodology Findings Recommendations Conclusion
![Page 3: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/3.jpg)
The Literature Statistics
Risk factors
The young, the old and men
Views…ED staff, patients
![Page 4: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/4.jpg)
Overcrowding
![Page 5: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/5.jpg)
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
![Page 6: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/6.jpg)
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
![Page 7: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/7.jpg)
Intentional Self-harm
Definition:
Attempted suicide Suicidal ideation Deliberate self-
harm
![Page 8: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/8.jpg)
Methodology Descriptive research Retrospective review Data extraction tool Variables:
Person Presentation
Inclusion/exclusion
Sent Ethics proposal
![Page 9: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/9.jpg)
After Ethics
Retrieved data Log book Sample:
48 people 73 re-presentations
Analysis: SPSS
![Page 10: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/10.jpg)
Findings
Coding Documentation/Assessments Cultural input Physical/mental health Support people Challenging behaviours Time to re-presentation
![Page 11: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/11.jpg)
Coding
Patients are coded by their presenting complaint, irrespective of the intent
Identifying this population difficult
Previously identified 120 people presented 852 times
![Page 12: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/12.jpg)
Type of ISH
Overdose Burn Laceration Gassing Attempted hanging Ingestion/insertion foreign body Head injury Stabbing self Traffic Jumping from a height
![Page 13: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/13.jpg)
Documentation/Assessment
Location of person often briefly described
Poor documentation of risk assessments
Inadequate triage assessment Patient discharged without ED staff
being aware
![Page 14: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/14.jpg)
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.
![Page 15: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/15.jpg)
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)
![Page 16: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/16.jpg)
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.
![Page 17: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/17.jpg)
Physical/mental health
Ambulatory Care service – ‘quick’
Nil checking of previous presentations
Nil highlighting on the IT system
![Page 18: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/18.jpg)
Support people1st Presentation
2nd Presentation
Family/Whānau/ friends
33 (45%) 24 (32%)
Health Worker
10 (14%) 13 (18%)
Police 0 (0%) 2 (3%)
Unknown 1 (1%) 1 (1%)
None documented
29 (40%) 33 (46%)
![Page 19: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/19.jpg)
Challenging Behaviours
Occurred in approximately 25% of presentations
Scenario: Person N presents to ED with lacerations to her lower legs. While waiting in a cubicle, she tries to set light to herself. She requires restraint and two security staff to ensure her safety.
![Page 20: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/20.jpg)
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%)
![Page 21: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/21.jpg)
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
![Page 22: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/22.jpg)
Recommendations
Training and supervision
Psychiatric staff in ED
Cultural assessment/input
![Page 23: Emergency department re-presentations following intentional self-harm](https://reader033.fdocuments.us/reader033/viewer/2022060200/559936791a28abf6168b464a/html5/thumbnails/23.jpg)
Conclusion Number of
presentations? – no idea…
ED important for providing care
Population is vulnerable, distressed and at high risk of suicide