The impact of the Emergency Department target upon the discharge decision for people who self-harm
| Published date | 07 October 2019 |
| Pages | 89-97 |
| DOI | https://doi.org/10.1108/JPMH-01-2019-0003 |
| Date | 07 October 2019 |
| Author | Michael Brian Haslam,Emma S. Jones |
| Subject Matter | Health & social care,Mental health,Public mental health |
The impact of the Emergency Department
target upon the discharge decision
for people who self-harm
Michael Brian Haslam and Emma S. Jones
Abstract
Purpose –The purpose of this paper is to consider the influence of the Emergency Department (ED)
target wait time upon the discharge decision in ED, specifically for patients who have self-harmed.
Pressuresto discharge patients to avoid breachingthe 4-h target wait time, potentiallyincrease the risk of
adverse responses from clinicians. For the patient who has self-harmed, such interactions may be
experiencedas invalidating and may result in adverse outcomes.
Design/methodology/approach –Secondary data analysis was applied to the retrospective referral
data of a Mental HealthLiaison Team (MHLT), collected over a periodof 11 months from a single hospital
in the North of England. In total, 734 episodes of care were referred to the team from ED, where the
primarypresentation was recorded as self-harm.
Findings –Over half of patients referred to the MHLT from ED having self-harmed were seen after
already breachingthe target and the potential for a more restrictiveoutcome reduced. Of those patients
seen within4 h, the potential for a more restrictivetreatment option was increased.
Practical implications –Recommendations to improve the patient journey for those who have self-
harmedinclude mental health triage and treatmentin clinical areas outside of the target.
Social implications –This study challenges theconcept of the target as being realistic and attainable
for patientswho have self-harmed.
Originality/value –This exploratory study providesa starting point from which to explore the impact of
the target time upon discharge decisions and clinical outcomes specifically for those who have self-
harmed.
Keywords Self-harm, Emergency Department, Target, Clinical outcomes, Mental healthliaison,
Wait times
Paper type Research paper
Background
The 4-h target wait time was introduced at Emergency Departments (EDs) in the UK to
reduce the time that patients attending ED, waited either to be admitted to a ward,
transferred or discharged (DH, 2001). Regarded as a simple measure of quality, the
target is perceived to have improved the patient journey through the reduction in wait
times for patients attending ED. Concerns, however, have been raised around the
potential negative influence of the target upon workload and the quality of care delivered
(Mortimore and Cooper, 2007;Haslam, 2019). Additionally, performance against the
target, currently set at 95 per cent, have fallen nationally, with only 77.2 per cent of all
attendances currently meeting the target (Nuffield Trust, 2019). Nationally, this
performance dropped to its lowest at 75.7 per cent, in February 2019; the longest waits
occurring in January and February due to an increase in respiratory illness and falls in the
elderly and inpatient bed shortages.
Michael Brian Haslam is
based at Edge Hill
University, Ormskirk, UK.
Emma S. Jones is based at
the University of Central
Lancashire, Preston, UK.
Received 3 January 2019
Revised 7 August 2019
28 August 2019
Accepted 5 September 2019
DOI 10.1108/JPMH-01-2019-0003 VOL. 19 NO. 2 2020, pp. 89-97, ©Emerald Publishing Limited, ISSN 1746-5729 jJOURNAL OF PUBLIC MENTAL HEALTH jPAGE 89
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