Adolescent self harm patients: audit of assessment in an accident and emergency department.

Abstract

OBJECTIVE--To examine the assessment of adolescent self harm patients attending an accident and emergency department. DESIGN--Retrospective assessment of case notes. SETTING--Accident and emergency department, Leicester Royal Infirmary. PATIENTS--210 adolescent patients (aged 9-19 years) attending the department during 1 January 1989-31 December 1989 after deliberate self poisoning; records were available for 200. MAIN OUTCOME MEASURES--Numbers of admissions, discharges from department without either a psychiatric consultation or some form of follow up, and discharges with either of these; scoring of adequacy of psychiatric and social assessment by accident and emergency doctor. RESULTS--89 patients were admitted (mean score 5.1, excluding 22 patients too drowsy or unforthcoming for proper assessment), 80 were discharged without specific psychiatric consultation or other follow up (mean score 5.4), and 31 were discharged with psychiatric consultation or other follow up (mean score 9.1). The percentage of patients in each group whose assessment by the accident and emergency doctor was considered to be adequate or better than adequate over 10 headings ranged from 0%-40% for admitted patients, 0%-50% for those discharged without psychiatric assessment, and 0%-61% in the remaining group. Overall, in almost half (49%, 54/111) of all of those discharged documentation of the suicidal state was inadequate. CONCLUSION--The assessment of many adolescent self harm patients in this clinic was unsatisfactory. IMPLICATIONS--Doctors working in accident and emergency departments should be encouraged to liaise with child psychiatrists before discharging such patients.