Reliability of
            HEARTSMAP
            as a Tool for Evaluating Psychosocial Assessment Documentation Practices in Emergency Departments: A Methodologic Issue

AbstractObjectives: The commonest psychiatric presentation in most emergency departments (EDs) is deliberate self-harm. However, there are other significant categories of psychiatric presentation which include alcohol and substance misuse, acute psychosis and mood disorder. In addition to the NICE Guidelines for deliberate self-harm, there are good practice guidelines available for the management of other psychiatric attendances to the ED. The aim of this study was to identify the psychiatric attendances other than deliberate self-harm to Beaumont Hospital ED over a 12-month period with the objective of studying the rates and characteristics of attendances and to investigate whether good practice guidelines were met.Method: From a total of 657 psychiatric attendances other than deliberate self-harm which were recorded, data was collected on demographics, provision of a psychosocial assessment and adherence to good practice guidelines.Results: Alcohol (38%) was the most common reason for presentation. Of the total number of attendees, only 44% received a psychosocial assessment compared to 59% of attendees who had presented following deliberate self-harm during the same 12-month period.Conclusions: The attendees who did not receive a psychosocial assessment represent a vulnerable group in which the levels of psychosocial assessment need to be improved in order to meet good practice guidelines standards of care.

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Reliability of HEARTSMAP as a Tool for Evaluating Psychosocial Assessment Documentation Practices in Emergency Departments for Pediatric Mental Health Complaints

Academic Emergency Medicine ◽

10.1111/acem.13506 ◽

2018 ◽

Vol 25 (12) ◽

pp. 1375-1384 ◽

Cited By ~ 3

Author(s):

Carson Gill ◽

Brendan Arnold ◽

Sean Nugent ◽

Alykhan Rajwani ◽

Michael Xu ◽

...

Keyword(s):

Mental Health ◽

Emergency Departments ◽

Psychosocial Assessment ◽

Health Complaints ◽

Pediatric Mental Health

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Is There a Case for Using Social Outcomes in Self-Harm Research?

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.170 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S295-S295

Author(s):

P. Huxley ◽

N. Ahmed

Keyword(s):

Emergency Departments ◽

Social Outcomes ◽

Psychosocial Assessment ◽

Social Intervention ◽

Outcome Indicators ◽

Social Interventions ◽

Significant Difference ◽

Self Harm ◽

Competing Interest ◽

Hospital Emergency Departments

IntroductionSelf-harm is costly to individuals and health services and has high associated risks of further self-harm and completed suicide. Self-harm presentations to hospitals offer an opportunity to engage patients in interventions to help reduce future episodes and associated costs. This presentation reviews clinical trials for self-harm interventions conducted over the past twenty years in hospital emergency departments (1996–2016) comparing successful vs. unsuccessful trials (defined by the whole or partial achievement of trial defined outcomes) in terms of methodology, type of intervention and type of outcome measure.MethodDatabases were searched using defined keywords. Randomized trials of adult subjects presenting to emergency departments were selected.ResultsTwenty-four studies are included in the review. There was no significant difference between the type of intervention and “success”, nor were there index/control differences by sample size and follow-up length. Most trials (79%) used re-admission to hospital after a further episode as the primary outcome; only 4 (16%) of the studies reported social outcomes. As an example of social interventions and outcomes, we discuss trial results of a new social intervention for adults (many of whom do not receive a (UK-mandated) psychosocial assessment), and who are usually provided with little/no support after leaving the emergency room.DiscussionThe findings suggest that the use of repetition and re-presentation as outcome indicators may be missing the importance of social precipitants of self-harm and the need to assess social circumstances, interventions and outcomes. We discuss findings from a new social intervention trial, which addresses these limitations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Emergency Departments Are Underutilized Sites for Suicide Prevention

Crisis ◽

10.1027/0227-5910/a000001 ◽

2010 ◽

Vol 31 (1) ◽

pp. 1-6 ◽

Cited By ~ 62

Author(s):

Gregory Luke Larkin ◽

Annette L. Beautrais

Keyword(s):

Suicide Prevention ◽

Emergency Departments

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Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽

10.1027/0227-5910/a000499 ◽

2018 ◽

Vol 39 (5) ◽

pp. 318-325 ◽

Cited By ~ 8

Author(s):

Barbara Stanley ◽

Glenn W. Currier ◽

Megan Chesin ◽

Sadia Chaudhury ◽

Shari Jager-Hyman ◽

...

Keyword(s):

Emergency Departments ◽

Suicide Attempts ◽

The United States ◽

Administrative Claims ◽

Suicide Attempters ◽

Self Injury ◽

Axis I ◽

Ed Visits ◽

External Causes ◽

Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

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