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
wait time upon the discharge decision in ED, specifically for patients who have self-harmed. Pressures to
discharge patients to avoid breaching the 4-h target wait time, potentially increase the risk of adverse
responses from clinicians. For the patient who has self-harmed, such interactions may be experienced as
invalidating and may result in adverse outcomes.
Design/methodology/approach – Secondary data analysis was applied to the retrospective referral data of
a Mental Health Liaison Team (MHLT), collected over a period of 11 months from a single hospital in the North
of England. In total, 734 episodes of care were referred to the team from ED, where the primary presentation
was recorded as self-harm.
Findings – Over half of patients referred to the MHLT from ED having self-harmed were seen after already
breaching the target and the potential for a more restrictive outcome reduced. Of those patients seen within
4 h, the potential for a more restrictive treatment option was increased.
Practical implications – Recommendations to improve the patient journey for those who have self-harmed
include mental health triage and treatment in clinical areas outside of the target.
Social implications – This study challenges the concept of the target as being realistic and attainable for
patients who have self-harmed.
Originality/value – This exploratory study provides a starting point from which to explore the impact of the
target time upon discharge decisions and clinical outcomes specifically for those who have self-harmed.