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Overwhelmed EDs are struggling to meet the needs of patients who are suicidal or self-harming

25 March 2024

Whilst triage times have improved, mental and physical assessments must happen quicker to reduce the risk of absconding.

The findings are contained in the interim report of RCEM’s three-year Quality Improvement Programme (QIP) published today (25 March 2024) on Mental Health (Self-Harm).

The QIP collated and analysed data and captured patient experiences from 137 Emergency Departments (EDs) across all four nations.

It found that patients presenting to an ED requiring treatment for mental health (self-harm), some with high risks of further self-harm and suicide, many have physical and mental health needs that require to be treated concurrently (parallel care).

In this QIP, the primary focus included three main standards:

  1. Improving the ED mental health triage process
  2. Identifying at risk patients of further self-harm or absconding including observation of these patients while in ED
  3. Quality of ED clinical assessment.

The QIP team, led by Dr Fiona Burton, EM Consultant, and co-chair of the RCEM Quality Assurance and Improvement (QA&I) committee made the following recommendations:

  • Accurate and timely (close to patient attendance) data entry
  • Participating ED’s to focus on the three fundamental standards
  • Parallel assessment should be encouraged and incorporated into practise
  • Evidence of compassionate and practical care to be captured better
  • Capacity assessment is the responsibility of all involved in care and not the sole responsibility of the triage nurse
  • Safeguarding / drug and alcohol concerns to be considered and addressed in all cases
  • Patients leaving prior to ED clinician or Adult Psychiatric Liaison Services review should have a follow up plan arranged and documented. General Practitioners (GP’s) can be an option in some cases. They should not be the default position for all patients. Process should be in place for follow up of these patients.

Dr Adrian Boyle, President of the Royal College of Emergency Medicine (RCEM) said:

“This work is vital to ensure we are doing everything possible to support this highly vulnerable patient group throughout their care in the ED.

“Whilst some progress has been made, patients with mental health problems are still spending too long in our Emergency Departments, with an average length of stay of nearly 10 hours and this has not really improved.

“This report prioritises areas of focus for the QIP’s second year as the risk of further harm and reattendance for this patient group is high.”

Mental illness comprises the largest single cause of disability in the UK. The care that this patient group needs is complex, and it is important emergency medicine endeavours to promote parity of esteem, challenge stigma and improve the care of this very vulnerable patient group.

The QIP focuses on both organisational policies and clinical care and is being run over a two-year period (4 October 2022 to 3 October 2024). In comparison to previous years this should give participating ED’s enough time to understand challenges faced and make changes that are effective and long lasting.

The RCEM Quality Assurance and Improvement Committee are committed to continually evaluating the QIPs and improving them to best support EDs and improve patient care.

Read the Mental Health (Self Harm) Interim report 2022/23 here.

And find out about RCEM’s other Quality Improvement Programmes and how to sign up to take part on the Quality Improvement pages of the RCEM Website.

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