Clinical pathways for suicidality in emergency settings: a public health priority

Wilhelm, Kay; Korczak, Viola; Tietze, Tad; Reddy, Prasuna

doi:10.1071/ah16008

Cited by 4 publications

(12 citation statements)

References 18 publications

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“…Figure 2 indicates that the PECC admits most of the suicidal patients, whereas the Acute Mental Health Ward admits most of the psychotic patients, with a large proportion of all MH patients being discharged from ED. This suggests these two groups of patients require different pathways and models of care 16,17 . Interestingly, the literature does not present a broad discussion about differences in interventions between PECCs and acute MH units.…”

Section: Discussionmentioning

confidence: 99%

“…This suggests these two groups of patients require different pathways and models of care. 16,17 Interestingly, the literature does not present a broad discussion about differences in interventions between PECCs and acute MH units. Indeed, despite some recognition from Nepean Hospital PECC that the most common presenting complaint to a PECC is suicidal ideation, and the most common diagnosis is adjustment disorder, 12 there is little discussion in the literature regards specific interventions used in PECCs.…”

Section: Effect Of the Pecc On Rates And Types Of Inpatient Admissionmentioning

confidence: 99%

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Months of May: Mental health presentations and the impact of a psychiatric emergency care centre on an inner‐city emergency department

Huber

Wilhelm

Landstra

2021

Emerg Medicine Australasia

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Objectives: The impact of psychiatric emergency care centres (PECCs) on ED mental health (MH) presentations has not been presented. We aim to compare demographics, diagnosis and admission frequency of patients presenting to an inner-city ED with MH complaints, before and for several years after the opening of a PECC. Methods: We collected ED patient data for the first 200 'mental health' presentations during the month of

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Section: Discussionmentioning

confidence: 99%

Section: Effect Of the Pecc On Rates And Types Of Inpatient Admissionmentioning

confidence: 99%

Months of May: Mental health presentations and the impact of a psychiatric emergency care centre on an inner‐city emergency department

Huber

Wilhelm

Landstra

2021

Emerg Medicine Australasia

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“…9 In our search of the literature, we did not find any clinical pathway for suicidality specifically geared to youth admitted to short-stay psychiatric inpatient units. We found clinical pathways for suicidality in emergency settings 44 which listed four suicidality pathways specifically for children and young people in the UK. [45][46][47][48] These were designed for young people in the local areas, administered at the emergency department but give context and some post discharge resources.…”

Section: Discussionmentioning

confidence: 99%

“…[45][46][47][48] These were designed for young people in the local areas, administered at the emergency department but give context and some post discharge resources. 44 The average length of stay on acute or short-term psychiatry inpatient units is about 7 days in adults, adolescents and children. 49,50 Therefore, the ideal brief suicide-specific psychotherapeutic intervention for the child or adolescent hospitalized on account of acute suicidal crisis would be for 3 to 9 sessions, provided over a short period of time, for example, 3 to 14 days, where the intervention is evidence based.…”

Section: Discussionmentioning

confidence: 99%

<p>Development of a Clinical Pathway for the Assessment and Management of Suicidality on a Pediatric Psychiatric Inpatient Unit</p>

Boafo

Greenham

Cloutier³

et al. 2020

AHMT

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Purpose: This article describes steps taken by a mental health inpatient multidisciplinary team to develop a clinical pathway for the assessment and management of suicidality in a pediatric psychiatric inpatient unit. Patients and Methods: The setting for this project is a 19-bed inpatient psychiatry unit providing care for children and adolescents (6-17 years of age) in a tertiary care pediatric hospital in Ontario, Canada. Three Lean methodologies were used: 1) The A3 process was used to articulate a problem statement and help clarify expectations, determine goals, and uncover, address and encourage discussion of potential issues; 2) Process mapping was used to show how work process activities are sequenced from the time of the patient's admission to discharge; and 3) Standard work, where consideration was given to the breakdown of the work into categories which are sequenced, organized and repeatedly followed. Generally accepted methodologies for developing clinical pathways were used to create a framework and algorithm for the assessment and management of suicidality in psychiatrically hospitalized children and adolescents. Results: The clinical pathway development resulted in six steps from admission to discharge: intake process, inclusion/exclusion criteria, data integration and treatment formulation, interventions, determination of readiness for discharge, and the discharge process. Conclusion: This framework, developed with the aim to standardize care for psychiatrically admitted suicidal children and adolescents, may serve as a flexible template for use in similar settings and could be adapted according to local realities and resources.

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“…EDs are an important and often primary point of access for mental health support services [8,9,10] and therefore provide and opportunity for suicide-risk screening and prevention [2]. However, the population of individuals affected by suicidal behaviours is highly heterogeneous and poses significant challenges for risk assessment and clinical management, especially in emergency settings [11].…”

Section: Introductionmentioning

confidence: 99%

Mapping patient interactions in psychiatric presentations to a tertiary emergency department

McCullough

Small

Jayawardena

et al. 2023

Preprint

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Reliable assessment of suicide and self-harm risk in emergency medicine is critical for effective intervention and treatment of patients affected by mental health disorders. Teams of clinicians are faced with the challenge of rapidly integrating medical history, wide-ranging psychosocial factors, and real-time patient observations to inform diagnosis, treatment and referral decisions. Patient outcomes therefore depend on the reliable flow of information though networks of clinical staff and information systems. We studied information flow at a systems-level in a tertiary hospital emergency department using network models and machine learning. Data were gathered by mapping trajectories and recording clinical interactions for patients at suspected risk of suicide or self-harm. A network model constructed from the data revealed communities closely aligned with underlying clinical team structure. By analysing connectivity patterns in the network model we identified a vulnerability in the system with the potential to adversely impact information flow. We then developed an algorithmic strategy to mitigate this risk by targeted strengthening of links between clinical teams. Finally, we investigated a novel application of machine learning for distinguishing specific interactions along a patient’s trajectory which were most likely to precipitate a psychiatric referral. Together, our results demonstrate a new framework for assessing and reinforcing important information pathways that guide clinical decision processes and provide complimentary insights for improving clinical practice and operational models in emergency medicine for patients at risk of suicide or self-harm.

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Clinical pathways for suicidality in emergency settings: a public health priority

Cited by 4 publications

References 18 publications

Months of May: Mental health presentations and the impact of a psychiatric emergency care centre on an inner‐city emergency department

Months of May: Mental health presentations and the impact of a psychiatric emergency care centre on an inner‐city emergency department

<p>Development of a Clinical Pathway for the Assessment and Management of Suicidality on a Pediatric Psychiatric Inpatient Unit</p>

Mapping patient interactions in psychiatric presentations to a tertiary emergency department

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