Care-pathways for patients presenting to emergency ambulance services with self-harm: national survey. Issue 12 (3rd September 2020)

• Record Type: Journal Article
• Authors: Zayed, Mohammed Gaber; Williams, Victoria; Glendenning, Alexander Charles; Bulger, Jenna Katherine; Hewes, Tom; Porter, Alison; Snooks, Helen; John, A
• Is Part Of: Emergency medicine journal. Volume 37:Issue 12(2020)
• Page Start: 752
• Page End: 755
• Publication Date: 2020-09-03
• Subjects: self harm -- emergency ambulance systems, education -- prehospital care, basic ambulance care -- mental health, self harm -- paramedics, clinical management; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2019-208967
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Background: Self-harm is among the top five causes of acute hospital admissions and ambulance clinicians are often the first point of contact. However, the Emergency Department (ED) may not be the most appropriate place of care and little is known about the existence or nature of alternative pathways available to UK ambulance services. This survey describes the current management pathways used by ambulance services for patients who have self-harmed. Methods: A structured questionnaire was sent to all UK ambulance services by email and followed up by telephone in 2018. Three independent researchers (two clinical) coded responses which were analysed thematically. Results: All 13 UK ambulance services responded to the survey: nine by email and four by telephone interview. Two services reported a service-wide protocol for managing people presenting with self-harm, with referral to mental health crisis team available as an alternative to conveyance to ED, following on-scene psychosocial assessment. Four services reported local pathways for managing mental health patients which included care of patients who had self-harmed. Four services reported being in the process of developing pathways for managing mental health patients. Six services reported no service-wide nor local pathways for managing self-harm patients. No robust evaluation of new care models was reported. Conclusion: Practice in ambulance services in the UK is variable, with a minority having a specific clinical pathway for managing self-harm, with an option to avoid ED. New pathways for patients who have self-harmed must be evaluated in terms of safety, clinical and cost-effectiveness.