AN EXAMINATION OF THE ACCIDENT AND EMERGENCY MANAGEMENT OF DELIBERATESELF-HARM

Objective-To examine the adequacy of assessment and management of deli berate self harm (DSH) undertaken by accident and emergency (A&E) medi cal staff. Methods-The records for attendances to the Leicester Royal Infirmary A&E department with a diagnosis of ''self inflicted'' injury for the 12 month period April 1994 to March 1995 were scrutinised. If the episode was identified as DSH, then assessment and management wer e examined, using an instrument based on the Royal College of Psychiat rists) standards of service for the general hospital management of adu lt DSH. Results-There were 934 episodes of DSH involving 854 patients. The mean age was 32 (SD 14.2), with an even sex distribution. Overdos e was by far the most common method of DSH (91.5%). Information concer ning suicide intent was documented in 70% of cases, and psychiatric hi story in 67%. Less information was recorded for medical history (50%), mental state (51%), recent stress (55%), or previous DSH (47%), and o nly 23% had an assessment of risk of further DSH. Very little was reco rded concerning alcohol or substance misuse. In 291 cases (31%), the p atient was discharged directly home by A&E medical staff, and 50 of th ese were referred for psychiatric outpatient follow up; 210 (23%) were referred for specialist assessment in the department and 423 (45.5%) were admitted to medical/surgical wards. The frequency with which info rmation was recorded varied significantly between outcome groups. At n ight A&E staff were far more Likely to discharge a patient home themse lves than refer for specialist assessment (P << 0.001). Conclusions-Wi th over half the sample not admitted, the responsibility for the initi al risk assessment lies with A&E medical staff. The study reveals a ne ed for improved planning and delivery of services.