Acute hospital reconfiguration and self-harm presentations: a before-and-after study

Griffin, Eve; Murphy, Catherine; Perry, Ivan J.; Lynch, Brenda; Arensman, Ella; Corcoran, Paul

doi:10.1007/s11845-018-1797-y

Cited by 4 publications

(3 citation statements)

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“…It can be hypothesised that when ED services are halted or reduced in one location, nearby hospitals can expect to see pressures on patient flows from the ED to in-patient beds unless capacity is increased in the new destination hospital. In Ireland, there is evidence to suggest that the reconfiguration of hospital services has impacted on patterns of patient flow specifically for those presenting with self-harm in the Mid-West 35. EDs that are geographically further from the closed ED would also be expected to be less impacted by an increase in the number of attendances from that hospital 34.…”

Section: Introductionmentioning

confidence: 99%

An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015

et al. 2019

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ObjectivesTo understand the impact of emergency department (ED) reconfiguration on the number of patients waiting for hospital beds on trolleys in the remaining EDs in four geographical regions in Ireland using time-series analysis.SettingEDs in four Irish regions; the West, North-East, South and Mid-West from 2005 to 2015.ParticipantsAll patients counted as waiting on trolleys in an ED for a hospital bed in the study hospitals from 2005 to 2015.InterventionThe system intervention was the reconfiguration of ED services, as determined by the Department of Health and Health Service Executive. The timing of these interventions varied depending on the hospital and region in question.ResultsThree of the four regions studied experienced a significant change in ED trolley numbers in the 12-month post-ED reconfiguration. The trend ratio before and after the intervention for these regions was as follows: North-East incidence rate ratio (IRR) 2.85 (95% CI 2.04 to 3.99, p<0.001), South IRR 0.68 (95% CI 0.51 to 0.89, p=0.006) and the Mid-West IRR 0.03 (95% 1.03 to 2.03, p=0.03). Two of these regions, the South and the Mid-West, displayed a convergence between the observed and expected trolley numbers in the 12-month post-reconfiguration. The North-East showed a much steeper increase, one that extended beyond the 12-month period post-ED reconfiguration.ConclusionsFindings suggest that the impacts of ED reconfiguration on regional level ED trolley trends were either non-significant or caused a short-term shock which converged on the pre-reconfiguration trend over the following 12 months. However, the North-East is identified as an exception due to increased pressures in one regional hospital, which caused a change in trend beyond the 12-month post reconfiguration.

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Section: Introductionmentioning

confidence: 99%

An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015

et al. 2019

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“…Studies employing these designs have primarily utilised hospital records and data recorded via self-harm registries. [13][14][15][16][17][18][19] However, a systematic review that examined aspects of routine clinical care following self-harm (eg, hospital admission or specialist follow-up) found little evidence for their role in reducing repeat self-harm and suicide, 20 despite evidence from individual studies being used to inform several guidance. 21 22 The reasons for a lack of evidence from observational studies may reflect the size and representativeness of the samples used, the quality of study design, as well as the consistency, quality and range of outcomes used.…”

Section: Open Accessmentioning

confidence: 99%

Study designs and outcomes used in evaluation studies of hospital-presenting self-harm: protocol for a methodological systematic review

et al. 2021

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IntroductionSelf-harm is the most common risk factor for suicide, and so those who present to hospital following self-harm provide an opportunity for targeted clinical care interventions. Observational studies evaluating such interventions may be useful in overcoming limitations of controlled trials, but study design, statistical analyses and outcomes used must be appropriate. This methodological systematic review will describe, categorise, synthesise and compare the methodological aspects of studies evaluating interventions and aspects of clinical management following hospital-presenting self-harm in both observational and experimental (ie, controlled trials or quasi-experimental studies) study designs.Methods and analysisPreferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocol guidelines were followed in drafting this protocol. Search terms were developed (related to self-harm, hospital presentation and evaluation studies) and adapted for MEDLINE, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and grey literature databases. Two reviewers will independently screen 100 titles/abstracts until consensus is reached, with the remaining screened by one reviewer. Full-text screening will be conducted independently by two reviewers. Data will be extracted by one reviewer, and a second will check all data extracted. Validated risk of bias tools will be used. Data synthesis will focus on the heterogeneity of outcomes used in individual studies. Descriptive summary statistics of the data (eg, key study characteristics, type and frequency of outcomes) will be provided in categorical format, using frequencies and percentages. Outcomes will be reported separately for trials (both randomised and non-randomised trials), observational and quasi-experimental studies. Categorisation of outcomes will be guided by Cochrane Effective Practice and Organisation of Care resources for reviews of health systems interventions.Ethics and disseminationResults will be disseminated at national and international conferences and published in a peer-reviewed journal. Findings will be used to inform future studies in the area of hospital-presenting self-harm. Ethical approval is not required for this review.PROSPERO registration numberCRD42020208714.

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“…While initiatives such as this have the potential to increase the provision of evidence-based care, their outcomes have been under-researched. 21 22 Some recent natural experiment studies have shown how changes in service delivery impact on patterns of self-harm, including hospital reconfiguration 23 and expansion of liaison psychiatry services. 24 25 However, there are virtually no studies examining the impact of national programmes for the clinical management of self-harm in hospital settings.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the impact and implementation of a national clinical programme for the management of self-harm in hospital emergency departments: study protocol for a natural experiment

et al. 2021

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BackgroundA National Clinical Programme for the Management of Hospital-Presenting Self-Harm (NCP-SH) was introduced in Ireland in 2014. This involved the development of a model of care to standardise the management of self-harm in emergency departments, to be delivered by dedicated clinical nurse specialists. The core components of the programme were to: ensure an empathic and timely response, conduct a biopsychosocial assessment, involve family members in assessment and discharge planning, and provide a bridge to next care. The overall aim of the programme was to reduce the rate of repeat self-harm. This multistage study will evaluate the impact of the NCP-SH on hospital-presenting self-harm and to identify determinants influencing its implementation.MethodsEmploying a sequential mixed methods design, the first stage will use data from the National Self-Harm Registry Ireland to examine the impact of the NCP-SH on self-harm repetition, along with other aspects of care, including provision of psychosocial assessments and changes in admissions and postdischarge referrals. A cost-effectiveness analysis will assess the cost per repeat self-harm attendance avoided as a result of the NCP-SH. The second stage will identify the influences of implementation fidelity—adherence to the programme’s core components—using a combination of document analysis and semistructured interviews with staff of the programme, guided by the Consolidated Framework for Implementation Research.Ethics and disseminationThis study has received full ethical approval and will run until August 2023. This study is novel in that it will identify important factors influencing successful implementation of complex programmes. It is expected that the findings will provide important learnings for the integration of mental health services in general hospital settings and will be disseminated via peer-review publications along with reports for clinicians and policy-makers.

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Acute hospital reconfiguration and self-harm presentations: a before-and-after study

Abstract: There is evidence to suggest that acute hospital reconfiguration of hospital services impacts on patterns of patient flow. Findings have implications for those implementing reconfiguration of acute services.

Cited by 4 publications

References 4 publications

An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015

An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015

Study designs and outcomes used in evaluation studies of hospital-presenting self-harm: protocol for a methodological systematic review

Evaluation of the impact and implementation of a national clinical programme for the management of self-harm in hospital emergency departments: study protocol for a natural experiment

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