Variations in the hospital management of self harm in adults in England: observational study
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7448.1108 (Published 06 May 2004) Cite this as: BMJ 2004;328:1108
Data supplement
Table A Hospital services scale with number of hospitals for each aspect of hospital service structure, delivery, or management: results derived from interviews with key emergency and mental health service staff at 32 hospitalsNo of hospitals with service in place
1
Is there a protocol/guideline/aide memoire for staff in the emergency department for the immediate medical management of self harm patients?*
31
2
Is there a protocol/guideline/aide memoire for staff in the emergency department for the immediate assessment of risk and severe mental disorder for self harm patients?
17
3
Is there a designated self harm specialist clinical service?†
23
4
Is there a local specific planning/working group (of the team who undertake the psychosocial assessments) which meets at least once a year to plan/oversee the service for self-harm patients?
15
5
Are there psychosocial assessment training sessions for new staff who are involved in the psychosocial assessment of patients?‡
26
6
Are there supervision arrangements in place for staff members who undertake psychosocial assessments?§
14.5
(23x0.5; 3x1)§
7
Are there written guidelines/a checklist, to assist clinicians in the psychosocial assessment of self-harm patients?
15
8
Does the emergency department have 24 hour access to a psychiatrist, psychiatric nurse or social worker who is able to undertake psychosocial assessments?
30
9
If yes to 8, is immediate (within 15 minutes) advice available over the telephone?
26
10
If yes to 8, is emergency attendance, when requested, available within 1 hour?¶
18.5
(11x0.5; 13x1)¶
11
Do regular (at least once a year) service planning/strategy meetings take place between the self-harm team/psychiatric service and the general medical service involved in the care of self harm patients?
14
12
Are rooms which allow for privacy and confidentiality available for conducting interviews with self-harm patients either in or close to the emergency department?
16
13
Are rooms which allow for privacy and confidentiality available for conducting interviews with self-harm patients either in or close to the inpatient unit where most of the patients are assessed?
21
14
Does a formal arrangement exist with Social Services to visit and offer advice to self-harm patients who have significant social difficulties?#
11
15
Can those admitted as inpatients remain in hospital until they have received a psychosocial assessment?
29
16
Is there a policy stating that a patient’s GP should be contacted within 24 hours of patient discharge from an emergency department?**
16
17
Is there a policy stating that a patient’s GP should be contacted within 24 hours of patient discharge from an inpatient unit?**
21
18
Are self harm patients routinely given printed material about local services, voluntary groups and how to obtain access to them?
10
19
Are there any formal links with non-statutory services (eg self help groups, the Samaritans)?††
5
20
Has a system been set up for the monitoring of hospital attendance/discharge and referral of self harm patients?
7
21
Has there been any audit of the service for self-harm patients in the last 2 years?
17
*routine use of the Manchester triage system or/and a toxicology database were considered equivalent to management guidelines.
†where at least one member of mental health staff was based at the general hospital and was responsible for carrying out psychosocial assessments.
‡training at induction (including experiential training) for at least one group of staff involved in the psychosocial assessment of patients at the general hospital.
§0=no supervision, 0.5=weekly or elective, 1=ongoing.
¶1=yes, 0.5=usually, 0=no.
#in A&E or within self-harm service based at the general hospital
**posted <24 hours except at weekends.
††involvement in the planning of self-harm services for the general hospital.
Self harm admissions data, derived from national Hospital Episodes Statistics (HES), were used to compute readmission rates for all Hospital Trusts in England. Readmission rates are only a proxy measure of repetition as the proportion of self harm admissions who are re-admitted is higher in hospitals that admit a larger proportion of cases from A&E.
To control for these effects when sampling, we conducted a linear regression analysis using as our outcome measure the proportion of self harm patients admitted to each hospital who were re-admitted in the subsequent 6 months. In the absence of data on the proportion of self harm patients admitted to a hospital bed, we controlled for its effect on self harm readmission rates by adding a term for the number of self harm admissions to a hospital as a proportion of all first attendances at each hospital’s A&E department. To control for the influence of socioeconomic deprivation on the incidence of self harm we further controlled for the Townsend score, a census derived aggregate measure of socioeconomic deprivation. The residuals from this regression analysis represent the difference between the predicted and the actual readmission rate for each hospital – positive residuals suggest the hospital’s repetition rate is higher than expected, negative residuals indicate it is lower than expected.
For each region we randomly sampled:
(a) one hospital with a higher than predicted readmission rate from hospitals with admission rates below the median for that region;
(b) one hospital with a higher than predicted readmission rate from hospitals with admission rates above the median for that region;
(c) one hospital with a lower than predicted readmission rate from hospitals with admission rates below the median for that region;
(d) one hospital with a lower than predicted readmission rate from hospitals with admission rates above the median for that region
Note that the one hospital that declined participation was replaced by a randomly selected hospital from within the appropriate stratum.
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