Perspectives of emergency department staff on the triage of mental health‐related presentations: Implications for education, policy and practice

Gerdtz, Marie; Weiland, Tracey J; Jelinek, George A; Mackinlay, Claire; Hill, Nicole

doi:10.1111/j.1742-6723.2012.01592.x

Cited by 26 publications

(16 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Findings from this study have previously been reported in relation to the optimal management of mental health related presentations, barriers to operation of mental health legislation, management of mental health conditions in rural and remote settings and the triage of mental health related problems [5-8]. In this particular study, we explore the perceived knowledge gaps of ED staff and the areas in which they lacked confidence in assessing and managing people presenting with mental health conditions.…”

Section: Introductionmentioning

confidence: 83%

See 1 more Smart Citation

Knowledge and confidence of Australian emergency department clinicians in managing patients with mental health-related presentations: findings from a national qualitative study

et al. 2013

Self Cite

View full text Add to dashboard Cite

BackgroundMental health related presentations are common in Australian Emergency Departments (EDs). We sought to better understand ED staff knowledge and levels of confidence in treating people with mental health related problems using qualitative methods.MethodsThis was a qualitative learning needs analysis of Australian emergency doctors and nurses regarding the assessment and management of mental health presentations. Participants were selected for semi-structured telephone interview using criterion-based sampling. Recruitment was via the Australasian College for Emergency Medicine and College of Emergency Nursing Australasia membership databases. Interviews were audio-recorded and transcribed verbatim. Thematic framework analysis was used to identify perceived knowledge gaps and levels of confidence among participants in assessing and managing patients attending EDs with mental health presentations.ResultsThirty-six staff comprising 20 doctors and 16 nurses consented to participate. Data saturation was achieved for four major areas where knowledge gaps were reported. These were: assessment (risk assessment and assessment of mental status), management (psychotherapeutic skills, ongoing management, medication management and behaviour management), training (curriculum and rotations), and application of mental health legislation. Participants’ confidence in assessing mental health patients was affected by environmental, staff, and patient related factors. Clinicians were keen to learn more about evidence based practice to provide better care for this patient group. Areas where clinicians felt the least confident were in the effective assessment and management of high risk behaviours, providing continuity of care, managing people with dual diagnosis, prescribing and effectively managing medications, assessing and managing child and adolescent mental health, and balancing the caseload in ED.ConclusionParticipants were most concerned about knowledge gaps in risk assessment, particularly for self-harming patients, violent and aggressive patients and their management, and distinguishing psychiatric from physical illness. Staff confidence was enhanced by better availability of skilled psychiatric support staff to assist in clinical decision-making for complex cases and via the provision of a safe ED environment. Strategies to enhance the care of patients with mental health presentations in Australian emergency departments should address these gaps in knowledge and confidence.

show abstract

Section: Introductionmentioning

confidence: 83%

“…Study oversight was by a research team with meetings, and email contact, to oversee development of the interview schedule and data analyses. Detailed accounts of methods employed have previously been published [5-8]. …”

Section: Methodsmentioning

confidence: 99%

Knowledge and confidence of Australian emergency department clinicians in managing patients with mental health-related presentations: findings from a national qualitative study

et al. 2013

Self Cite

View full text Add to dashboard Cite

show abstract

“…Previous research into EDMHT has focused on the competence and confidence of emergency department nurses to perform mental health triage (Broadbent et al ., 2002; 2004), comparisons between the triage of people with mental illness in the emergency department by emergency department nurses and psychiatric nurses (Happell et al ., ), the learning needs and attitudes of emergency department staff to the triage of people with mental health problems (Sivakumar et al ., ; Weiland et al ., ; Gerdtz et al ., ), violence risk assessment at triage (Sands et al ., ), mental health triage of the agitated patient (Nordstrom et al ., ), mental health triage in disaster settings (Brannen et al ., ), and the consumer and carer perspective on the process of EDMHT (Clarke et al ., ; Morphet et al ., ).…”

Section: Introductionmentioning

confidence: 99%

“…Recent research has identified that the ATS clinical descriptors might be unreliable for guiding mental health triage assessment (Creaton et al ., ; Gerdtz et al ., , ; Broadbent et al ., ). Creaton et al .…”

Section: Introductionmentioning

confidence: 99%

Investigating the predictive validity of an emergency department mental health triage tool

Sands

Elsom

Berk

et al. 2013

Nursing & Health Sciences

View full text Add to dashboard Cite

Emergency department mental health triage is a complex clinical task for which the evidence base is minimal.Research in the past decade has consistently identified issues associated with the accuracy and consistency of mental health triage assessment. In this study, we investigated the predictive validity of the clinical descriptors in the Victorian Emergency Department Mental Health Triage Tool. Using a naturalistic, retrospective study design, an audit of the emergency department triage database was undertaken on 12 months of continuous data for all mental health presentations (n = 1718). The main outcome measure was urgency categorization. The study findings indicate that triage nurses can accurately identify the urgency of mental health presentations using defined clinical criteria. A significant finding was that patients with acute psychotic symptoms were more likely to be triaged as high urgency (code 2); however, the Australasian Triage Scale, in use in all Australian and many international emergency departments, provides no mental health-specific descriptors in high-urgency categories (1 and 2).

show abstract

“…These peculiar non-technical skills may then be cultivated in staff working in general emergency departments to ease the issues of skepticism, stigma, and criticism. This is especially relevant as research is demonstrating that 1) confidence may be lacking in these areas (Betz et al, 2013;Gerdtz et al, 2012;Gordon, 2012;Van Boekel et al, 2013), 2) that programs to improve staff competencies may be beneficial in emergency settings (Robinson et al, 2013;Smart et al, 1999;Woo et al, 2007), especially in psychiatric care (Alakeson et al, 2010), and 3) that the demand for psychiatric expertise in general emergency services will likely increase (Larkin & Beautrais, 2015).…”

Section: Introductionmentioning

confidence: 99%

Which skills boost service provider confidence when managing people presenting with psychiatric emergencies?

Poremski

Lim

Kunjithapatham

et al. 2016

Int J Mental Health Nurs

View full text Add to dashboard Cite

ABSTRACT:The way service seekers interact with the staff at emergency services has been shown to influence the standard of care, especially in the case of certain psychiatric manifestations. Staff reactions to psychiatric complaints have been linked to their comfort dealing with these types of service users as well as their competencies understanding the illness. It is therefore vital to understand which skills increase confidence in treating psychiatric emergencies.Twenty-six open-ended convergent interviews were conducted with staff working in a psychiatric emergency department. Thematic analysis was used to analyze the data. Participants reported several non-technical skills which developed from exclusively serving people with psychiatric emergencies: 1) Vigilance allowed staff to be sensitive to minor changes in behavior which precede psychiatric emergencies. 2) The ability to negotiate and find tangible solutions was particularly important when dealing with psychiatric complaints which may not have tangible resolutions.3) The ability to appraise social support networks allowed staff to plan follow-up actions and ensure continuity of care when support was available. 4) The ability to self-reflect allowed participants to learn from their experience and avoid burnout, frustration, and fatigue. Participants also reported several other clinical skills which they gained during training, including teamwork, de-escalating techniques and risk assessment. Tentatively speaking, these skills improve staff's confidence when treating psychiatric emergencies. Certain skills may be generalized to staff working in medical emergency departments who frequently encounter psychiatric complaints.

show abstract

Perspectives of emergency department staff on the triage of mental health‐related presentations: Implications for education, policy and practice

Cited by 26 publications

References 18 publications

Knowledge and confidence of Australian emergency department clinicians in managing patients with mental health-related presentations: findings from a national qualitative study

Knowledge and confidence of Australian emergency department clinicians in managing patients with mental health-related presentations: findings from a national qualitative study

Investigating the predictive validity of an emergency department mental health triage tool

Which skills boost service provider confidence when managing people presenting with psychiatric emergencies?

Contact Info

Product

Resources

About