The impact of the Emergency Department target upon the discharge decision for people who self-harm

Abstract

Purpose – The purpose of this paper is to consider the influence of the Emergency Department (ED) target \nwait time upon the discharge decision in ED, specifically for patients who have self-harmed. Pressures to \ndischarge patients to avoid breaching the 4-h target wait time, potentially increase the risk of adverse \nresponses from clinicians. For the patient who has self-harmed, such interactions may be experienced as \ninvalidating and may result in adverse outcomes. \nDesign/methodology/approach – Secondary data analysis was applied to the retrospective referral data of \na Mental Health Liaison Team (MHLT), collected over a period of 11 months from a single hospital in the North \nof England. In total, 734 episodes of care were referred to the team from ED, where the primary presentation \nwas recorded as self-harm. \nFindings – Over half of patients referred to the MHLT from ED having self-harmed were seen after already \nbreaching the target and the potential for a more restrictive outcome reduced. Of those patients seen within \n4 h, the potential for a more restrictive treatment option was increased. \nPractical implications – Recommendations to improve the patient journey for those who have self-harmed \ninclude mental health triage and treatment in clinical areas outside of the target. \nSocial implications – This study challenges the concept of the target as being realistic and attainable for \npatients who have self-harmed. \nOriginality/value – This exploratory study provides a starting point from which to explore the impact of the \ntarget time upon discharge decisions and clinical outcomes specifically for those who have self-harmed.