How the emergency department four-hour target affects clinical outcomes for patients diagnosed with a personality disorder

Abstract

The Emergency Department (ED) may already be an invalidating environment for those patients diagnosed with a personality disorder, with negative attitudes from staff perpetuating feelings of dismissal and rejection. Despite, however, personality disorder being more prevalent across health services including EDs, there is a lack of literature considering how achieving the target may take a priority over clinical need, leading to adverse outcomes for those patients diagnosed with a personality disorder.
Expanding on Hardern’s application of the concept of Destructive Goal Pursuit to the four-hour target, existing literature is used to illustrate how pressures to meet the four-hour target may a lead to distortions of clinical priorities and to adverse clinical outcomes for this patient group.
This paper challenges the concept of the target as being realistic and helpful to those patients specifically diagnosed with a personality disorder. Recommendations for practice include the use of short-stay units, where patients may be treated outside of the target wait time and the introduction of mental health triage in ED to improve the delivery of psychosocial assessments.