Self-harm patients who take early discharge from the accident and emergency department: How do they differ from those who stay?

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Abstract

There is evidence that patients presenting at a hospital Accident and Emergency (A&E) department with self-harm are considerably more likely than many others to discharge themselves before their assessment or treatment are complete. This paper reports a study that is part of a broader analysis of all self-harm presentations to a hospital A&E department over a five-year period. Self-harm patients who chose to remain for assessment and treatment were compared with those who chose to discharge themselves prematurely.

We found a mean proportion of 18% of self-harm patients per annum took early discharge between 1996 and 2000 and noted that these patients were more likely than other self-harm patients to have consumed alcohol in the hours immediately prior to their self-harm and attendance at the hospital. Self-harm patients who took early discharge were less likely than other self-harm patients to be admitted to an in-patient bed and less likely to receive a psychosocial assessment from a mental health specialist. We also found that aftercare arrangements were significantly less likely to be made for those patients who took early discharge. Some suggestions are made about approaches that clinical staff could adopt in order to reduce early discharge in self-harm patients.

Section snippets

Background

It has been estimated that across the whole of the United Kingdom there are over 170,000 hospital referrals for deliberate self-harm (DSH) every year. Self-harm has been identified in the National Service Framework for Mental Health (Department of Health, 1999a) as having a particularly close association with completed suicide and its reduction will therefore be crucial to achieving the government target of a 20% cut in the rate of completed suicide by 2010 (Department of Health, 1999b).

It is

Method

Over the years 1996–2000 a psychiatric liaison nurse (JT) prospectively recorded details of all consecutive A&E attendances of patients presenting with DSH. Where possible, data were collected in face-to-face interviews with patients. When this was not possible, such as those cases where patients had already been discharged, were unconscious or had been judged not to require specialist psychosocial assessment, A&E casualty cards and hospital case notes were searched for basic information. In

Results

Between 1996 and 2000 the hospital A&E department dealt with 4329 episodes of self-harm in patients aged 16 or over. During this time 2417 first attendances were recorded, none of these patients having presented in the year prior to the commencement of the study. The majority of the 2417 patients were female (ratio 52:48) with ages ranging from 16 to 88 years (mean 34.52; SD 14.06). The most commonly used methods of self-harm were self-poisoning (89.2% of attendances) and laceration (8.3%).

At

Discussion

Because the unit under study is relatively geographically isolated from other general hospitals it is probable that almost all patients referred for A&E care from the surrounding area would have attended this particular hospital and so will appear in the data reported here. This may not be the case in studies conducted in large urban areas with a choice of A&E facilities. We accept that because the study was restricted to one general hospital in a mixed rural/urban area it may not be typical of

Acknowledgements

We acknowledge the assistance of the psychiatric liaison nursing team and other members of staff from the Conwy and Denbighshire NHS Trust in conducting this study. We also thank the NHS Executive North West for funding the research.

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