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29 Investigating the population characteristics, processes and outcomes of pre-hospital psychiatric and self-harm emergencies in scotland: a national record linkage study
  1. E Duncan1,
  2. C Best1,
  3. N Dougall2,
  4. S Skar1,
  5. D Fitzpatrick3,
  6. J Evans1,
  7. A Corfield4,
  8. I Goldie5,
  9. M Maxwell1,
  10. H Snooks6,
  11. C Stark7,
  12. C White5,
  13. W Wojcik8
  1. 1University of Stirling
  2. 2Edinburgh Napier University
  3. 3Scottish Ambulance Service
  4. 4NHS Greater Glasgow and Clyde
  5. 5Mental Health Foundation
  6. 6Swansea University
  7. 7NHS Highland
  8. 8NHS Lothian

Abstract

Aim To investigate the demographic characteristics, care pathways, and clinical and service outcomes of people who present to ambulance services with a psychiatric or self-harm emergency

Methods We conducted a retrospective cohort study of patients attended by the Scottish Ambulance Service in 2011 with ambulance clinician attendance codes relating to ‘psychiatric emergency’ or ‘self-harm’. Patients resident in Scotland and>=16 years on first contact were included. We used NHS Scotland’s Unscheduled Care Data Mart (1) to link data from: – the ambulance service; emergency departments (ED); general and psychiatric inpatient hospital admissions episodes; and death records.

Results There were 9014 calls from 6802 people. Slightly more males (n=4708, 52%) than females (n=4306, 48%) were attended. Most were discharged from ED with no known follow-up (n=4566; 51%). Some were left at home (n=1003 attendances, 11%). Almost half of the people (n=3238, 48%) made at least one repeat call. People who self-discharge from ED were more likely to have another ambulance attendance for psychiatric emergency/self-harm within the same year (Pearson chi square=5.24, p=0.02). Two hundred and seventy-nine (4%) people died within the study period, 97 (35%) were recorded as suicide. Ethical approval (NRES 15/EM/0260) and other data approvals were received.

Conclusion While linked data analysis may not identify all relevant cases, it provides important information to guide the development and evaluation of evidence-based interventions. Ambulance service and ED are missing opportunities to improve outcomes for people who experience a psychiatric emergency or who self-harm. New interventions could lead to decreases in the number of suicides, episodes of self-harm and levels of patient distress; and ambulance and ED service use.

Reference

  1. Information Services Division (NHS Scotland) (2016) Unscheduled Care Datamart Background Paper. Accessible at http://www.isdscotland.org/Health-Topics/Emergency-Care/Patient-Pathways/unscheduledcare_background.pdf Accessed on 13/01/17

Conflict of interest None declared.

Funding Scottish Government, Chief Scientists Office

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