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

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.