Background Suicidal ideation is an increasingly common presentation to the paediatric emergency department. The presence of suicidal ideation is linked to acute psychiatric hospital admission and increased risk of suicide. The paediatric emergency department plays a critical role in reducing risk of suicide, strengthening protective factors and encouraging patient engagement with ongoing care. Aims This rapid review aims to synthesise evidence on interventions that can be implemented in the paediatric emergency department for children and adolescents presenting with suicidal ideation. Method Six electronic databases were searched for studies published since January 2010: PubMed, Web of Science, Medline, PsycINFO, CINAHL and Cochrane. Outcomes of interest included suicidal ideation, engagement with out-patient services, incidence of depressive symptoms, hopelessness, family empowerment, hospital admission and feasibility of interventions. The Cochrane risk-of-bias tool was used to evaluate the quality of studies. Results Six studies of paediatric emergency department-initiated family-based (n = 4) and motivational interviewing interventions (n = 2) were narratively reviewed. The studies were mainly small and of varying quality. The evidence synthesis suggests that both types of intervention, when initiated by the paediatric emergency department, reduce suicidal ideation and improve patient engagement with out-patient services. Family-based interventions also showed a reduction in suicidality and improvement in family empowerment, hopelessness and depressive symptoms. Conclusions Paediatric emergency department-initiated interventions are crucial to reduce suicidal ideation and risk of suicide, and to enhance ongoing engagement with out-patient services. Further research is needed; however, family-based and motivational interviewing interventions could be feasibly and effectively implemented in the paediatric emergency department setting.

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AimsTo reduce variability in the management of young people with mental health problems in hospital by improving communication and joint working between Paediatrics, Child and Adolescent Mental Health Services (CAMHS) and Emergency Medicine (EM) teams within our region.MethodIn order to identify the problems affecting the management of young people with mental health problems in hospital, a series of meetings was held with doctors, nursing staff and allied health professionals from the Paediatrics, CAMHS and EM teams in two hospitals in our region. 17 different issues were raised at these meetings. Using a structured questionnaire, teams identified the three most important of these to be: 1. Management of young people with acute behavioural disturbance; 2. Poor communication between teams; and 3. Insufficient training of hospital staff. Three interventions were then developed to address these problems. First, multidisciplinary team debriefs were introduced at each hospital, providing all three teams with an opportunity to discuss challenging cases. Second, an interprofessional study day on the management of acute behavioural disturbance was developed and delivered by members of the CAMHS, Paediatrics and EM teams. Third, a group of Paediatric nurses visited the local CAMHS inpatient unit to discuss nursing issues with the specialist CAMHS nursing team.ResultsFeedback from debriefs was universally positive, and they will now run six-monthly at each hospital. The study day has run twice, with a total of 75 attendees. Pre- and post-course feedback forms showed a marked improvement in confidence managing acute behavioural disturbance across all staff groups attending. This course will now run three times per year. Additionally, all those who visited the inpatient unit reported that it would lead to a positive change in their practice.ConclusionThese efforts to bring teams together have been highly valued by all involved, and we are receiving ongoing support from our deanery to continue this work. Several further joint-working initiatives are now being developed within our region as a result of this project, showing the positive and far-reaching repercussions of these relatively simple interventions.