Stewart Claire, Spicer Maureen, Babl Franz E
Emergency Department and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
J Paediatr Child Health. 2006 Nov;42(11):726-30. doi: 10.1111/j.1440-1754.2006.00959.x.
To explore management issues in adolescents with mental health problems who presented to a children's hospital emergency department (ED).
Retrospective chart review of all mental health presentations of adolescents (12-18 years) to a tertiary children's hospital ED, over a 1-year period (2003-2004). Patients were identified based on a search of the electronic ED log. Medical and mental health records were manually abstracted.
There were 203 presentations during the study period. Eighteen per cent of patients presented more than once. Mean age was 14.7 years, 73% were female and 67% presented after 6 pm. Fifty-seven per cent presented with non-accidental overdose, self-harm or suicide risk. There were 110 security incidents in 26% of presentations during the ED stay. A total of 47% were admitted, 27% to the medical inpatient service and 20% to a psychiatric inpatient facility.
Adolescent mental health presentations to the ED require a high number of ED, mental health and inpatient service resources. Security incidents occur frequently. We propose changes to address identified problems. These include redesigning the physical structure of the ED, more mental health training and support for ED staff, better access to mental health records and crisis plans for adolescents at risk, and improved after-hours mental health services for children and adolescents.
探讨前往儿童医院急诊科（ED）就诊的有心理健康问题的青少年的管理问题。
对一家三级儿童医院急诊科在1年期间（2003 - 2004年）所有青少年（12 - 18岁）心理健康就诊情况进行回顾性病历审查。通过搜索电子急诊科日志来识别患者。手动提取医疗和心理健康记录。
研究期间有203次就诊。18%的患者不止一次就诊。平均年龄为14.7岁，73%为女性，67%在下午6点后就诊。57%的患者表现为非意外过量用药、自我伤害或自杀风险。在急诊科停留期间，26%的就诊中有110起安全事件。共有47%的患者被收治，27%入住内科住院部，20%入住精神科住院机构。
青少年到急诊科的心理健康就诊需要大量的急诊科、心理健康和住院服务资源。安全事件频繁发生。我们提议做出改变以解决已发现的问题。这些改变包括重新设计急诊科的物理结构，为急诊科工作人员提供更多心理健康培训和支持，更好地获取有风险青少年的心理健康记录和危机计划，以及改善儿童和青少年的夜间心理健康服务。
