Rhodes Anne E, Bethell Jennifer, Newton Amanda S, Antony Jesmin, Tonmyr Lil, Bhanji Farhan, Chaulk David, Curtis Sarah, Gouin Serge, Joubert Gary I, Porter Robert, Silver Norman, Spruyt Jennifer, Thompson Graham Cameron, Turner Troy W S
Keenan Research Centre, St Michael'sHospital, Toronto, Ontario,Canada.
Pediatr Emerg Care. 2012 Nov;28(11):1124-8. doi: 10.1097/PEC.0b013e3182712981.
Given the public health importance of suicide-related behaviors and the corresponding gap in the performance measurement literature, we sought to identify key candidate process indicators (quality of care measures) and structural measures (organizational resources and attributes) important for emergency department (ED) management of pediatric suicide-related behaviors.
We reviewed nationally endorsed guidelines and published research to establish an inventory of measures. Next, we surveyed expert pediatric ED clinicians to assess the level of agreement on the relevance (to patient care) and variability (across hospitals) of 42 candidate process indicators and whether 10 hospital and regional structural measures might impact these processes.
Twenty-three clinicians from 14 pediatric tertiary-care hospitals responded (93% of hospitals contacted). Candidate process indicators identified as both most relevant to patient care (≥87% agreed or strongly agreed) and most variable across hospitals (≥78% agreed or strongly agreed) were wait time for medical assessment; referral to crisis intervention worker/program; mental health, psychosocial, or risk assessment requested; any inpatient admission; psychiatric inpatient admission; postdischarge treatment plan; wait time for first follow-up appointment; follow-up obtained; and type of follow-up obtained. Key hospital and regional structural measures (≥87% agreed or strongly agreed) were specialist staffing and type of specialist staffing in or available to the ED; regional policies, protocols, or procedures; and inpatient psychiatric services.
This study highlighted candidate performance measures for the ED management of pediatric suicide-related behaviors. The 9 candidate process indicators (covering triage, assessment, admission, discharge, and follow-up) and 4 hospital and regional structural measures merit further development.
鉴于自杀相关行为对公共卫生的重要性以及绩效评估文献中相应的空白，我们试图确定对儿科自杀相关行为的急诊科管理重要的关键候选过程指标（护理质量指标）和结构指标（组织资源和属性）。
我们查阅了国家认可的指南和已发表的研究，以建立指标清单。接下来，我们对儿科急诊科专家临床医生进行了调查，以评估他们对42个候选过程指标的相关性（与患者护理的相关性）和变异性（不同医院之间）的认同程度，以及10个医院和地区结构指标是否可能影响这些过程。
来自14家儿科三级护理医院的23名临床医生做出了回应（占联系医院的93%）。被确定为与患者护理最相关（≥87%同意或强烈同意）且在不同医院之间变异性最大（≥78%同意或强烈同意）的候选过程指标包括：医疗评估等待时间；转介至危机干预工作者/项目；要求进行心理健康、心理社会或风险评估；任何住院治疗；精神科住院治疗；出院后治疗计划；首次随访预约等待时间；获得随访；以及获得的随访类型。关键的医院和地区结构指标（≥87%同意或强烈同意）包括：急诊科内或可提供的专科人员配备及专科人员配备类型；地区政策、方案或程序；以及住院精神科服务。
本研究突出了儿科自杀相关行为急诊科管理的候选绩效指标。9个候选过程指标（涵盖分诊、评估、住院、出院和随访）以及4个医院和地区结构指标值得进一步研究。
