AUDIT OF PSYCHIATRIC EMERGENCIES IN THE A-AND-E DEPARTMENT OF AN URBAN GENERAL-HOSPITAL

Objectives: To ascertain the frequency and nature of emergencies refer red to psychiatrists at the A & E Department of an urban teaching gene ral hospital. Deliberate self-harm and other forms of violence were to be special foci of the study, as was substance abuse, particularly al cohol abuse. Clinical management strategies used by psychiatric emerge ncy staff were also to be assessed. Method: A retrospective audit was made of all of the reports of emergencies written by psychiatric train ees (who were first on call to the A & E) during a six-month period (J anuary-June, 1991). The reports were analysed according to demographic characteristics, main clinical problem, presence or absence of each s pecial focus problem, and also clinical management strategies. Main ou tcome measures were recorded as percentages of relevant groupings. Mea n and median ages were reported as indicated. Results: The 550 emergen cy psychiatric reports represented 2.2% of A & E attendances. Fifty-tw o percent were male and 70% were between 15 and 44 years of age. Forty -eight percent resided outside the psychiatric catchment area of St. J ames's Hospital. Forty-six percent of all psychiatric emergencies requ ired careful assessment of suicidal potential; twenty percent were adm itted to inpatient care, 53% were referred to out-patient or day-patie nt care, 7% to their general practitioner and just 3% to social servic es. Conclusions: 1. Emergency assessment at the A & E provides a consi derable workload for the psychiatric service of an urban general hospi tal. 2. Careful assessment of suicidal potential still represents an i mportant part of this emergency work. 3. Only 1 in 5 patients were ref erred on to in-patient care. Undue pressure should not be placed on ps ychiatric trainees to manage potentially suicidal patients outside hos pital. 4. Few referrals were made by psychiatric trainees to general p ractitioners or to the social services, suggesting that more formal co nsultant supervision of trainees in this emergency work is warranted.